Healthcare Provider Details

I. General information

NPI: 1043302763
Provider Name (Legal Business Name): JACQUELINE RENEE RUZGA DOCTOR OF CHIROPRACT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 BLACK ROCK TPK SUITE 9
FAIRFIELD CT
06825
US

IV. Provider business mailing address

2490 BLACK ROCK TPKE 355
FAIRFIELD CT
06825
US

V. Phone/Fax

Practice location:
  • Phone: 203-372-7333
  • Fax: 203-372-1348
Mailing address:
  • Phone: 203-372-7333
  • Fax: 203-372-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number000621
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number17369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: