Active NPI
Kelly Donn Rudd, D.C.
- Chiropractor
- Tomah, WI
National Provider Identifier
1992871149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1712
- Practice address
- 500 N Superior Ave
Tomah, WI 54660-1114 - Phone
- (608) 372-3348
- Fax
- (608) 372-5693
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1712 | WI | Primary |
Addresses
Primary practice location
500 N Superior Ave
Tomah, WI 54660-1114
Mailing address
500 N Superior Ave
PO Box 937
Tomah, WI 54660-1114
Phone (608) 372-3348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38775000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1712 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992871149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 N SUPERIOR AVE",
"address_2": "PO BOX 937",
"city": "TOMAH",
"state": "WI",
"postal_code": "546601114",
"telephone_number": "608-372-3348",
"fax_number": "608-372-5693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N SUPERIOR AVE",
"city": "TOMAH",
"state": "WI",
"postal_code": "546601114",
"telephone_number": "608-372-3348",
"fax_number": "608-372-5693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDD",
"first_name": "KELLY",
"middle_name": "DONN",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "1712",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38775000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.