MEDICARE: DR. FRED W. RUHE III DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038006192	IL
2	111NI0900X	Internist Chiropractor	038006192	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350019072	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06182296	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194718932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED W. RUHE III DC

Provider Business Mailing Address
First Line	:	21104 WASHINGTON PKWY
Second Line	:	BROOKSIDE OFFICE COURT
City	:	FRANKFORT
State	:	IL
Zip	:	60423
Country	:	US
Telephone Number	:	815-277-2442
Fax Number	:	815-277-2448

Provider Business Practice Location Address
First Line	:	21104 WASHINGTON PKWY
Second Line	:	BROOKSIDE OFFICE COURT
City	:	FRANKFORT
State	:	IL
Zip	:	60423
Country	:	US
Telephone Number	:	815-277-2442
Fax Number	:	815-277-2448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	06/07/2010

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