Healthcare Provider Details

I. General information

NPI: 1871691998
Provider Name (Legal Business Name): BRIAN STEPHEN RUGGIERO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 MAIN ST
MANCHESTER CT
06040-6013
US

IV. Provider business mailing address

1047 MAIN ST
MANCHESTER CT
06040-6013
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-2888
  • Fax:
Mailing address:
  • Phone: 860-643-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0007548
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: