Provider Demographics
NPI:1710140769
Name:RURIK, GEOFF MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFF
Middle Name:MICHAEL
Last Name:RURIK
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 1:2151 HAMLINE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4236
Mailing Address - Country:US
Mailing Address - Phone:651-636-5560
Mailing Address - Fax:
Practice Address - Street 1:2151 HAMLINE AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4236
Practice Address - Country:US
Practice Address - Phone:651-636-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor