=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164526372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND MICHAEL RUSZKOWSKI D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2006
-----------------------------------------------------
Last Update Date | 04/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 692 N HOMESTEAD BLVD STE 104
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-242-6665
-----------------------------------------------------
Fax | 305-242-6919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 692 N HOMESTEAD BLVD STE 104
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-242-6665
-----------------------------------------------------
Fax | 305-242-6919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8062
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------