Provider Demographics
NPI:1659308997
Name:RUSTIGAN, RYAN A (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:RUSTIGAN
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 1:1360 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3838
Mailing Address - Country:US
Mailing Address - Phone:559-437-0606
Mailing Address - Fax:559-437-0116
Practice Address - Street 1:80 ALAMOS AVE APT 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3885
Practice Address - Country:US
Practice Address - Phone:559-437-0606
Practice Address - Fax:559-437-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0294160Medicare ID - Type UnspecifiedPROVIDER #