Individual
DR. THEA MARIE RUDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
80 23RD AVE N, FORREST CHIROPRACTIC OFFICES, CLINTON, IA 52732-1417
(563) 242-8026
(563) 242-0016
Mailing address
203 CRAGMOR DR, CLINTON, IA 52732-1339
(563) 243-0018
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06577
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0443820
—
IA
01
—
06577
IOWA LICENSE #
IA
01
—
12819
OFFICE GROUP #
IA
01
—
36758
BCBS
IA
01
—
45-3076673
FEDERAL TAX ID #
IA
01
—
CJ5186
RR MEDICARE GROUP #
IA
01
—
P00137451
RAILROAD MEDICARE
IA
Enumeration date
01/19/2006
Last updated
12/27/2011
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