Provider Demographics
NPI:1063889590
Name:RUDEN-FORREST CHIROPRACTIC PC
Entity type:Organization
Organization Name:RUDEN-FORREST CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-243-8026
Mailing Address - Street 1:80 23RD AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2401
Mailing Address - Country:US
Mailing Address - Phone:563-243-8026
Mailing Address - Fax:563-242-0016
Practice Address - Street 1:80 23RD AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2401
Practice Address - Country:US
Practice Address - Phone:563-243-8026
Practice Address - Fax:563-242-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty