Healthcare Provider Details

I. General information

NPI: 1265508808
Provider Name (Legal Business Name): RAYMOND RUGINIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 OGDEN AVE
LISLE IL
60532
US

IV. Provider business mailing address

1025 OGDEN AVE
LISLE IL
60532
US

V. Phone/Fax

Practice location:
  • Phone: 630-963-1410
  • Fax: 630-963-1456
Mailing address:
  • Phone: 630-963-1410
  • Fax: 630-963-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: