Provider Demographics
NPI:1164526372
Name:RUSZKOWSKI, RAYMOND MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:RUSZKOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 N HOMESTEAD BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6237
Mailing Address - Country:US
Mailing Address - Phone:305-242-6665
Mailing Address - Fax:305-242-6919
Practice Address - Street 1:692 N HOMESTEAD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6237
Practice Address - Country:US
Practice Address - Phone:305-242-6665
Practice Address - Fax:305-242-6919
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382025400Medicaid
FL53944Medicare ID - Type Unspecified
FLU82534Medicare UPIN