Provider Demographics
NPI:1841520491
Name:RUOF, NATHAN TODD (DC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:TODD
Last Name:RUOF
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 1:10250 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4602
Mailing Address - Country:US
Mailing Address - Phone:708-423-1440
Mailing Address - Fax:708-423-1909
Practice Address - Street 1:10250 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4602
Practice Address - Country:US
Practice Address - Phone:708-423-1440
Practice Address - Fax:708-423-1909
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400193633Medicare PIN