Healthcare Provider Details

I. General information

NPI: 1851328710
Provider Name (Legal Business Name): CASE RUCKMAN DCPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W. CLAY STREET
ALBANY MO
64402
US

IV. Provider business mailing address

PO BOX 267
ALBANY MO
64402
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3322
  • Fax: 660-726-5285
Mailing address:
  • Phone: 660-868-0818
  • Fax: 660-726-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004598
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CASE ANDREW RUCKMAN
Title or Position: OWNER - AUTHORIZED OFFICIAL
Credential: DC
Phone: 816-244-3789