Provider Demographics
NPI:1982684403
Name:RUDEN, THEA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:MARIE
Last Name:RUDEN
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 1:203 CRAGMOR DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-1339
Mailing Address - Country:US
Mailing Address - Phone:563-243-0018
Mailing Address - Fax:
Practice Address - Street 1:80 23RD AVE N
Practice Address - Street 2:FORREST CHIROPRACTIC OFFICES
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-1417
Practice Address - Country:US
Practice Address - Phone:563-242-8026
Practice Address - Fax:563-242-0016
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12819OtherOFFICE GROUP #
IA0443820Medicaid
IA06577OtherIOWA LICENSE #
IA45-3076673OtherFEDERAL TAX ID #
IA36758OtherBCBS
IAP00137451OtherRAILROAD MEDICARE
IACJ5186OtherRR MEDICARE GROUP #
IA12819OtherOFFICE GROUP #
IAI12298Medicare ID - Type Unspecified
IAI11298Medicare PIN