MEDICARE: DR. KRIS RUSEK

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	XOO8039-1	NY

General Provider Information

NPI Number	:	1194992313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS RUSEK

Provider Business Mailing Address
First Line	:	6127 WOODSIDE AVE
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-3542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6127 WOODSIDE AVE
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-3542
Country	:	US
Telephone Number	:	718-358-5500
Fax Number	:

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	11/21/2008

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Directions to “ DR. KRIS RUSEK ” Practice Location

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