Provider Demographics
NPI:1891849360
Name:RUCKER, EMILY JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 47TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1880
Mailing Address - Country:US
Mailing Address - Phone:303-449-9355
Mailing Address - Fax:303-449-5367
Practice Address - Street 1:3434 47TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1880
Practice Address - Country:US
Practice Address - Phone:303-449-9355
Practice Address - Fax:303-449-5367
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU06053Medicare UPIN
COC17943Medicare ID - Type Unspecified