Provider Demographics
NPI:1508902826
Name:RUOPP, JACK RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:RICHARD
Last Name:RUOPP
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 1:3232 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4904
Mailing Address - Country:US
Mailing Address - Phone:573-335-7349
Mailing Address - Fax:573-335-4055
Practice Address - Street 1:3232 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4904
Practice Address - Country:US
Practice Address - Phone:573-335-7349
Practice Address - Fax:573-335-4055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112039OtherHEALTHLINK
MO12624OtherBLUECROSSBLUESHIELD