Provider Demographics
NPI:1851328710
Name:CASE RUCKMAN DCPC
Entity Type:Organization
Organization Name:CASE RUCKMAN DCPC
Other - Org Name:ALBANY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CASE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-244-3789
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402
Mailing Address - Country:US
Mailing Address - Phone:660-868-0818
Mailing Address - Fax:660-726-5285
Practice Address - Street 1:309 W. CLAY STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402
Practice Address - Country:US
Practice Address - Phone:660-726-3322
Practice Address - Fax:660-726-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004598111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500078273Medicaid
MO11297016OtherBLUE CROSS BLUE SHIELD
MO0005209Medicare ID - Type Unspecified