Provider Demographics
NPI:1528220613
Name:JAMES C RUGENSKI D.C.P.C.
Entity Type:Organization
Organization Name:JAMES C RUGENSKI D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:RUGENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-581-2576
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2954850Medicaid
OH25242Medicare PIN
T33741Medicare UPIN