=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740492636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH JAMES RUFF D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19016 BAY ST.
-----------------------------------------------------
City | EL VERANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-996-7833
-----------------------------------------------------
Fax | 707-935-6539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1940
-----------------------------------------------------
City | BOYES HOT SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95416-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-996-7833
-----------------------------------------------------
Fax | 707-935-6539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0133790
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------