Organization
RUDDELL CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN T RUDDELL D.C. (CHIROPRACTOR)
(208) 743-8401
Entity
Organization
Contact information
Practice address
1117 16TH AVE, LEWISTON, ID 83501-3739
(208) 743-8401
(208) 743-8722
Mailing address
1117 16TH AVE, LEWISTON, ID 83501-3739
(208) 743-8401
(208) 743-8722
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-503
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805054900
—
ID
Enumeration date
06/27/2007
Last updated
03/20/2017
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