MEDICARE: DR. JAMES S RUCKEL 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	111N00000X	Chiropractor	08001766	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350049797	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000531878	OTHER	IN	ANTHEMBC/BS

General Provider Information

NPI Number	:	1871582783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES S RUCKEL DC

Provider Business Mailing Address
First Line	:	7313 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6237
Country	:	US
Telephone Number	:	260-436-5200
Fax Number	:	260-436-1103

Provider Business Practice Location Address
First Line	:	7313 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6237
Country	:	US
Telephone Number	:	260-436-5200
Fax Number	:	260-436-1103

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	03/24/2008

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