Healthcare Provider Details

I. General information

NPI: 1619053576
Provider Name (Legal Business Name): BRIAN JON RUGGIERO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ATLANTA RD
CUMMING GA
30040-2609
US

IV. Provider business mailing address

233 ATLANTA RD
CUMMING GA
30040-2609
US

V. Phone/Fax

Practice location:
  • Phone: 770-888-4600
  • Fax: 770-888-4601
Mailing address:
  • Phone: 770-888-4600
  • Fax: 770-888-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number005583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: