MEDICARE: TOXIL RUCK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NP0017X	Pediatric Chiropractor	33538	CA

General Provider Information

NPI Number	:	1225810245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOXIL RUCK DC

Provider Business Mailing Address
First Line	:	1445 N GARDNER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4101
Country	:	US
Telephone Number	:	323-364-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 N GARDNER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4101
Country	:	US
Telephone Number	:	323-364-4840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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Directions to “ TOXIL RUCK DC” Practice Location

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