MEDICARE: DR. DRAKE ROBERT RUSTICI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2007017726	MO

General Provider Information

NPI Number	:	1194925602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DRAKE ROBERT RUSTICI D.C.

Provider Business Mailing Address
First Line	:	603ANEWOODS CHAPEL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1900
Country	:	US
Telephone Number	:	816-886-2035
Fax Number	:	816-503-8941

Provider Business Practice Location Address
First Line	:	603ANEWOODS CHAPEL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1900
Country	:	US
Telephone Number	:	816-886-2035
Fax Number	:	816-503-8941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	11/27/2015

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