Provider Demographics
NPI:1215151915
Name:RUCKI, LINDA (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:RUCKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LUYBEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-8903
Mailing Address - Country:US
Mailing Address - Phone:615-952-5253
Mailing Address - Fax:615-952-5255
Practice Address - Street 1:172 LUYBEN HILLS RD
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-8903
Practice Address - Country:US
Practice Address - Phone:615-952-5253
Practice Address - Fax:615-952-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC464111N00000X
CADC26131111N00000X
WACH00034196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2002036OtherBCBS OF TN
TN11532307OtherCAQH
TN11532307OtherCAQH
TNT74614Medicare UPIN