Provider Demographics
NPI:1619053576
Name:RUGGIERO, BRIAN JON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JON
Last Name:RUGGIERO
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 1:233 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2609
Mailing Address - Country:US
Mailing Address - Phone:770-888-4600
Mailing Address - Fax:770-888-4601
Practice Address - Street 1:233 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2609
Practice Address - Country:US
Practice Address - Phone:770-888-4600
Practice Address - Fax:770-888-4601
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005583111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation