Provider Demographics
NPI:1629154133
Name:RUDA, TRAVIS SMITH (DC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:SMITH
Last Name:RUDA
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 1:301 BIG HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2011
Mailing Address - Country:US
Mailing Address - Phone:859-353-8603
Mailing Address - Fax:859-353-8605
Practice Address - Street 1:301 BIG HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2011
Practice Address - Country:US
Practice Address - Phone:859-353-8603
Practice Address - Fax:859-353-8605
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002772Medicaid
KYK145871Medicare PIN
KYK145870Medicare PIN
KY85002772Medicaid
U93573Medicare UPIN