=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841520491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN TODD RUOF D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 02/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10250 CENTRAL AVE
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-423-1440
-----------------------------------------------------
Fax | 708-423-1909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10250 CENTRAL AVE
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-423-1440
-----------------------------------------------------
Fax | 708-423-1909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038.011589
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------