Healthcare Provider Details

I. General information

NPI: 1821101726
Provider Name (Legal Business Name): FRED W. RUHE III DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21104 WASHINGTON PKWY BROOKSIDE OFFICE COURT
FRANKFORT IL
60423
US

IV. Provider business mailing address

21104 WASHINGTON PKWY BROOKSIDE OFFICE COURT
FRANKFORT IL
60423
US

V. Phone/Fax

Practice location:
  • Phone: 815-277-2442
  • Fax: 815-277-2448
Mailing address:
  • Phone: 815-277-2442
  • Fax: 815-277-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038006192
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038006192
License Number StateIL

VIII. Authorized Official

Name: DR. FRED W. RUHE III
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 815-277-2442