Provider Demographics
NPI:1336188309
Name:RUCKER, ERIN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:OSTBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 ANDREWS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3769
Mailing Address - Country:US
Mailing Address - Phone:334-445-2525
Mailing Address - Fax:334-445-1212
Practice Address - Street 1:1550 ANDREWS AVE STE 2
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3769
Practice Address - Country:US
Practice Address - Phone:334-445-2525
Practice Address - Fax:334-445-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010356111N00000X
AL2468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532295OtherBLUE CROSS BLUE SHIELD