Provider Demographics
NPI:1174829402
Name:TOM RUCKMAN DC PC
Entity Type:Organization
Organization Name:TOM RUCKMAN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-747-6240
Mailing Address - Street 1:105 W Q ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2188
Mailing Address - Country:US
Mailing Address - Phone:541-747-6240
Mailing Address - Fax:541-747-1134
Practice Address - Street 1:105 W Q ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2188
Practice Address - Country:US
Practice Address - Phone:541-747-6240
Practice Address - Fax:541-747-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty