Provider Demographics
NPI:1629250477
Name:RUCKEL, INC.
Entity Type:Organization
Organization Name:RUCKEL, INC.
Other - Org Name:JAMES S RUCKEL DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-436-5200
Mailing Address - Street 1:7313 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6237
Mailing Address - Country:US
Mailing Address - Phone:260-436-5200
Mailing Address - Fax:260-436-1103
Practice Address - Street 1:7313 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6237
Practice Address - Country:US
Practice Address - Phone:260-436-5200
Practice Address - Fax:260-436-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350049797OtherMEDICARE RAILROAD
IN201041440Medicaid
IN000000531878OtherANTHEM BC/BS
IN201041440Medicaid
INU68754Medicare UPIN