Provider Demographics
NPI:1407154131
Name:RUES, MARK (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RUES
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 1502
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6215
Mailing Address - Country:US
Mailing Address - Phone:610-564-1293
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 1502
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6215
Practice Address - Country:US
Practice Address - Phone:610-564-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist