Provider Demographics
NPI:1801933502
Name:MCDONOUGH, RUTH KATHRYN (DC)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:KATHRYN
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:844 WEBSTER ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3459
Mailing Address - Country:US
Mailing Address - Phone:781-248-5019
Mailing Address - Fax:
Practice Address - Street 1:844 WEBSTER ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3459
Practice Address - Country:US
Practice Address - Phone:781-248-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8710347OtherCIGNA
MAY36768OtherBLUE CROSS BLUE SHIELD
MAAA36725OtherHARVARD PILGRIM
MA1231060OtherAETNA
MAY45434Medicare ID - Type Unspecified