Individual
DR. RUDOLPH A. THEOBALD
Active
Individual
DR. RUDOLPH A. THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
8869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104065
AMERIGROUP
TX
01
—
11384841
CAQH
TX
05
—
149696001
—
TX
01
—
1997117
FIRST HEALTH
TX
01
—
606350
BCBS PAR PLAN
TN
Enumeration date
10/25/2006
Last updated
06/21/2023
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