Provider Demographics
NPI:1043302763
Name:RUZGA, JACQUELINE RENEE (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RENEE
Last Name:RUZGA
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
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Mailing Address - Street 1:2490 BLACK ROCK TPKE
Mailing Address - Street 2:355
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-372-7333
Mailing Address - Fax:203-372-1348
Practice Address - Street 1:2452 BLACK ROCK TPK
Practice Address - Street 2:SUITE 9
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-372-7333
Practice Address - Fax:203-372-1348
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000621111NX0800X
CA17369111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1479068003OtherCIGNA
CT29721Other#29721
CT752213OtherCONNECTICARE
CTZS924OtherOXFORD
CT1034320OtherAETNA
CT29721OtherUS HEALTHCARE
NYX8E34OtherEMPIRE BC/BS/ NY
CT050000621CT01OtherBLUECROSS/BLUE SHIELD
CTACN646831OtherACN