Provider Demographics
NPI:1942361282
Name:DR RUCKERS WELLNESS CENTER INC
Entity Type:Organization
Organization Name:DR RUCKERS WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-635-1746
Mailing Address - Street 1:2305 W MIDVALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9455
Mailing Address - Country:US
Mailing Address - Phone:559-635-1746
Mailing Address - Fax:559-635-0493
Practice Address - Street 1:2305 W MIDVALLEY AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9455
Practice Address - Country:US
Practice Address - Phone:559-635-1746
Practice Address - Fax:559-635-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty