Provider Demographics
NPI:1124118351
Name:RYDBERG, ALLEN KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:KENNETH
Last Name:RYDBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 THOMPSON AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3219
Mailing Address - Country:US
Mailing Address - Phone:651-451-6839
Mailing Address - Fax:651-451-2928
Practice Address - Street 1:200 THOMPSON AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3219
Practice Address - Country:US
Practice Address - Phone:651-451-6839
Practice Address - Fax:651-451-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44-40114OtherMEDICA PROVIDER ID
MN5C661ROOtherBLUE CROSS BLUE SHIELD ID
MN231904OtherACN PROVIDER ID
MN2171353-000Medicare UPIN
MN350001564Medicare ID - Type UnspecifiedMEDICAR E #