Provider Demographics
NPI:1194718932
Name:RUHE, FRED W III (DC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:W
Last Name:RUHE
Suffix:III
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 1:21104 WASHINGTON PKWY
Mailing Address - Street 2:BROOKSIDE OFFICE COURT
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-277-2442
Mailing Address - Fax:815-277-2448
Practice Address - Street 1:21104 WASHINGTON PKWY
Practice Address - Street 2:BROOKSIDE OFFICE COURT
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-277-2442
Practice Address - Fax:815-277-2448
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006192111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06182296OtherBLUE CROSS BLUE SHIELD
350019072OtherRAILROAD MEDICARE
IL213987Medicare PIN
IL06182296OtherBLUE CROSS BLUE SHIELD
T87130Medicare UPIN
905450Medicare ID - Type Unspecified