Kevin Patrick Ruddell, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR 725 Issued in ID

Practice address

1117 16TH Avenue
Lewiston, ID 83501

Phone

(208) 743-8401

Fax

(208) 743-8722

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1992

Medicare assignment

May accept Medicare assignment

Group practices

Ruddell Chiropractic ClinicGroup PAC ID 5395907729, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ruddell Chiropractic Clinic

  • Chiropractor
  • Lewiston, ID
  • NPI 1225235906
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013072669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 16TH AVENUE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83501",
            "telephone_number": "208-743-8401",
            "fax_number": "208-743-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 16TH AVENUE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83501",
            "telephone_number": "208-743-8401",
            "fax_number": "208-743-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDELL",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIR 725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "000010024191",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT LABOR & INDUSTRIES",
            "identifier": "0190459",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "C7259",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monali Roy
• Royal Plaza Retirement Center Lewiston, LLC
• Tyra Darrean Ruberti
• Ruddell Chiropractic Clinic
• Brian T Ruddell, DC
• John Bradley Rudolph, D.O.
• Stephanie Lynn Ruggiero-Bodden, LMSW
• Pedro E Ruiz, D.M.D.
• Ryan Russell, PHARMD
• S.P.O.R.T. Physical Therapy Clinic

• Chiropractor in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.