Provider Demographics
NPI:1821101726
Name:FRED W. RUHE III DC PC
Entity Type:Organization
Organization Name:FRED W. RUHE III DC PC
Other - Org Name:RUHE CHIROPRACTICC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUHE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:815-277-2442
Mailing Address - Street 1:21104 WASHINGTON PKWY
Mailing Address - Street 2:BROOKSIDE OFFICE COURT
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-277-2442
Mailing Address - Fax:815-277-2448
Practice Address - Street 1:21104 WASHINGTON PKWY
Practice Address - Street 2:BROOKSIDE OFFICE COURT
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-277-2442
Practice Address - Fax:815-277-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006192111NI0900X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29895Medicare PIN
ILT87130Medicare UPIN