Provider Demographics
NPI:1073601217
Name:RUSNAK, MARK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:RUSNAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:19655 1ST AVE S
Mailing Address - Street 2:#205
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2166
Mailing Address - Country:US
Mailing Address - Phone:206-429-2922
Mailing Address - Fax:206-429-2422
Practice Address - Street 1:19655 1ST AVE S
Practice Address - Street 2:#205
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2166
Practice Address - Country:US
Practice Address - Phone:206-429-2922
Practice Address - Fax:206-429-2422
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WACH00034720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8870638Medicare PIN