Provider Demographics
NPI:1164414108
Name:RUGE, RODNEY E (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:E
Last Name:RUGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6130
Mailing Address - Country:US
Mailing Address - Phone:310-325-2500
Mailing Address - Fax:310-325-2524
Practice Address - Street 1:25200 CRENSHAW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6130
Practice Address - Country:US
Practice Address - Phone:310-325-2500
Practice Address - Fax:310-325-2524
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25268OtherSTATE LICENSE NUMBER
CADC25268OtherSTATE LICENSE NUMBER
CADC25268OtherSTATE LICENSE NUMBER