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General NPI Number Information
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NPI Number | 1699173559
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Entity Type | Organization
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Legal Business Name | LAWRENCE RUCK, DC PLLC
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 200 S BROADWAY SUITE 2-3
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City | TARRYTOWN
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State | NY
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Zip | 10591-4500
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Country | US
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Telephone | 914-844-7712
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Fax | 914-909-4453
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Provider Business Mailing Address
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Address Line | 200 S BROADWAY SUITE 2-3
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City | TARRYTOWN
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State | NY
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Zip | 10591-4500
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Country | US
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Telephone | 914-844-7712
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Fax | 914-909-4453
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE RUCK
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Credential | D.C.
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Telephone | 914-844-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 010628
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License Number State | NY
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