Healthcare Provider Details

I. General information

NPI: 1841520491
Provider Name (Legal Business Name): NATHAN TODD RUOF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 CENTRAL AVE
OAK LAWN IL
60453-4602
US

IV. Provider business mailing address

10250 CENTRAL AVE
OAK LAWN IL
60453-4602
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-1440
  • Fax: 708-423-1909
Mailing address:
  • Phone: 708-423-1440
  • Fax: 708-423-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011589
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: