Healthcare Provider Details

I. General information

NPI: 1538105028
Provider Name (Legal Business Name): AUGUST JOHN LA RUFFA III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-7546
US

IV. Provider business mailing address

654 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-7546
US

V. Phone/Fax

Practice location:
  • Phone: 561-745-1002
  • Fax: 561-745-7880
Mailing address:
  • Phone: 561-745-1002
  • Fax: 561-745-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH6529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: