Provider Demographics
NPI:1790968915
Name:RUSICK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RUSICK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-932-5200
Mailing Address - Street 1:10320 W MCDOWELL RD STE M1341
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4878
Mailing Address - Country:US
Mailing Address - Phone:623-932-5200
Mailing Address - Fax:632-932-5220
Practice Address - Street 1:10320 W MCDOWELL RD STE M1341
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4878
Practice Address - Country:US
Practice Address - Phone:623-932-5200
Practice Address - Fax:632-932-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0940410OtherBCBS
AZ488569OtherUPIN
AZAZ0940410OtherBCBS