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General NPI Number Information
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NPI Number | 1790968915
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Entity Type | Organization
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Legal Business Name | RUSICK CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 10320 W MCDOWELL RD STE M1341
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City | AVONDALE
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State | AZ
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Zip | 85392-4878
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Country | US
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Telephone | 623-932-5200
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Fax | 632-932-5220
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Provider Business Mailing Address
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Address Line | 10320 W MCDOWELL RD STE M1341
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City | AVONDALE
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State | AZ
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Zip | 85392-4878
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Country | US
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Telephone | 623-932-5200
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Fax | 632-932-5220
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. DAVID F RUSICK
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Credential | D.C.
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Telephone | 623-932-5200
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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 | 7155
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License Number State | AZ
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