Provider Demographics
NPI:1134205784
Name:RUTH, JEFFREY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:RUTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 WATAUGA RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3081
Mailing Address - Country:US
Mailing Address - Phone:817-281-0008
Mailing Address - Fax:817-281-7333
Practice Address - Street 1:5720 WATAUGA RD
Practice Address - Street 2:STE 100
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3081
Practice Address - Country:US
Practice Address - Phone:817-281-0008
Practice Address - Fax:817-281-7333
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609319Medicare ID - Type Unspecified