Provider Demographics
NPI:1265511349
Name:RUMACK, KENNETH D (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:RUMACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8496
Mailing Address - Street 2:
Mailing Address - City:SO LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158
Mailing Address - Country:US
Mailing Address - Phone:530-544-4996
Mailing Address - Fax:530-544-5308
Practice Address - Street 1:2877 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SO LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96158
Practice Address - Country:US
Practice Address - Phone:530-594-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA016044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0160440Medicare UPIN