Provider Demographics
NPI:1275526394
Name:RUSKOWSKI, KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:RUSKOWSKI
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 1:143A OLD HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2501
Mailing Address - Country:US
Mailing Address - Phone:270-756-5368
Mailing Address - Fax:270-756-1611
Practice Address - Street 1:143A OLD HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2501
Practice Address - Country:US
Practice Address - Phone:270-756-5368
Practice Address - Fax:270-756-1611
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85042745Medicaid
KY6070120Medicare ID - Type Unspecified
KY85042745Medicaid