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General NPI Number Information
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NPI Number | 1043108285
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Entity Type | Individual
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Provider Name | JOHN WESLEY RUSEN MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 417 MARKET ST
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City | KINGSTON
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State | PA
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Zip | 18704-5418
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Country | US
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Telephone | 570-283-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CLEVELAND ST APT 1
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City | PLAINS
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State | PA
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Zip | 18705-3304
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Country | US
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Telephone | 570-877-9500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | MSG005855
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License Number State | PA
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