MEDICARE: DR. AUGUST JOHN LA RUFFA III DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	CH6529	FL

General Provider Information

NPI Number	:	1538105028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUGUST JOHN LA RUFFA III DC

Provider Business Mailing Address
First Line	:	654 W INDIANTOWN RD
Second Line	:	SUITE 107
City	:	JUPITER
State	:	FL
Zip	:	33458-7546
Country	:	US
Telephone Number	:	561-745-1002
Fax Number	:	561-745-7880

Provider Business Practice Location Address
First Line	:	654 W INDIANTOWN RD
Second Line	:	SUITE 107
City	:	JUPITER
State	:	FL
Zip	:	33458-7546
Country	:	US
Telephone Number	:	561-745-1002
Fax Number	:	561-745-7880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/05/2008

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