Provider Demographics
NPI:1467404442
Name:LES D RUSKIN DC PA
Entity Type:Organization
Organization Name:LES D RUSKIN DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-785-2545
Mailing Address - Street 1:3488 E LAKE RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2404
Mailing Address - Country:US
Mailing Address - Phone:727-785-2545
Mailing Address - Fax:727-781-0617
Practice Address - Street 1:3488 E LAKE RD STE 102B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2404
Practice Address - Country:US
Practice Address - Phone:727-785-2545
Practice Address - Fax:727-781-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22482Medicare PIN
T98838Medicare UPIN