Provider Demographics
NPI:1659465797
Name:RUF, KENNETH HENRY JR (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:HENRY
Last Name:RUF
Suffix:JR
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 1:10811 XAVIS ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4037
Mailing Address - Country:US
Mailing Address - Phone:763-421-1905
Mailing Address - Fax:763-421-2517
Practice Address - Street 1:10811 XAVIS ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4037
Practice Address - Country:US
Practice Address - Phone:763-421-1905
Practice Address - Fax:763-421-2517
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59598RUOtherBC/BS PROVIDER #
MN662028100Medicaid
MN350000584Medicare ID - Type Unspecified
MN662028100Medicaid