Individual
DR. KEVIN PATRICK RUDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1117 16TH AVENUE, LEWISTON, ID 83501
(208) 743-8401
(208) 743-8722
Mailing address
1117 16TH AVENUE, LEWISTON, ID 83501
(208) 743-8401
(208) 743-8722
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR 725
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010024191
REGENCE
ID
01
—
0190459
DEPT LABOR & INDUSTRIES
—
01
—
C7259
BLUE CROSS
ID
Enumeration date
12/26/2006
Last updated
07/08/2007
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