Provider Demographics
NPI:1255332706
Name:JEAN, RUTH V (DC DABCO)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:V
Last Name:JEAN
Suffix:
Gender:F
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2108 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54642
Mailing Address - Country:US
Mailing Address - Phone:608-488-4855
Mailing Address - Fax:608-488-2188
Practice Address - Street 1:26 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-1728
Practice Address - Country:US
Practice Address - Phone:715-284-2915
Practice Address - Fax:715-284-7492
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38813400Medicaid
WI38813400Medicaid