Provider Demographics
NPI:1821047267
Name:RUBY, ROGER A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:RUBY
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 1:712 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1514
Mailing Address - Country:US
Mailing Address - Phone:712-324-5313
Mailing Address - Fax:
Practice Address - Street 1:712 4TH AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1514
Practice Address - Country:US
Practice Address - Phone:712-324-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1203422Medicaid
IATO1166Medicare UPIN
IA12007Medicare PIN