Healthcare Provider Details

I. General information

NPI: 1427145200
Provider Name (Legal Business Name): PAUL RUZILA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S WABASH AVE STE 290
CHICAGO IL
60605-3641
US

IV. Provider business mailing address

850 S WABASH AVE STE 290
CHICAGO IL
60605-3641
US

V. Phone/Fax

Practice location:
  • Phone: 312-212-1150
  • Fax: 312-212-1160
Mailing address:
  • Phone: 312-212-1150
  • Fax: 312-212-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: