Provider Demographics
NPI:1477699270
Name:RUGENSKI, JAMES CARL (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:RUGENSKI
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 1:15608 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2902
Mailing Address - Country:US
Mailing Address - Phone:313-581-2576
Mailing Address - Fax:313-581-1678
Practice Address - Street 1:15608 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2902
Practice Address - Country:US
Practice Address - Phone:313-581-2576
Practice Address - Fax:313-581-1678
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2954850Medicaid
MI2954850Medicaid