Provider Demographics
NPI:1871582783
Name:RUCKEL, JAMES S (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:RUCKEL
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 1:7313 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6237
Mailing Address - Country:US
Mailing Address - Phone:260-436-5200
Mailing Address - Fax:260-436-1103
Practice Address - Street 1:7313 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6237
Practice Address - Country:US
Practice Address - Phone:260-436-5200
Practice Address - Fax:260-436-1103
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350049797OtherMEDICARE RAILROAD
IN200156050AMedicaid
IN000000531878OtherANTHEMBC/BS
IN000000531878OtherANTHEMBC/BS