Provider Demographics
NPI:1033189725
Name:RUGEN, GLENN EDWARD (DC DABCN)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:RUGEN
Suffix:
Gender:M
Credentials:DC DABCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 KINDERHOOK ST
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184
Mailing Address - Country:US
Mailing Address - Phone:518-758-1400
Mailing Address - Fax:518-758-1438
Practice Address - Street 1:1002 KINDERHOOK ST
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-1400
Practice Address - Fax:518-758-1438
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003102 1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC031023OtherWORKERS COMP NO FAULT
NYC031023OtherWORKERS COMP NO FAULT
T53154Medicare UPIN