Provider Demographics
NPI:1790811966
Name:DAVID P AND MONA E RUSE
Entity Type:Organization
Organization Name:DAVID P AND MONA E RUSE
Other - Org Name:ALLEGAN CO. CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-673-5426
Mailing Address - Street 1:279 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8195
Mailing Address - Country:US
Mailing Address - Phone:269-673-5426
Mailing Address - Fax:269-673-5427
Practice Address - Street 1:279 THOMAS ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-8195
Practice Address - Country:US
Practice Address - Phone:269-673-5426
Practice Address - Fax:269-673-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2784 2745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT82934Medicare UPIN
MIT82935Medicare UPIN