Provider Demographics
NPI:1295899896
Name:BROWN-RUEGG, MATT (DC)
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:BROWN-RUEGG
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 1:1409 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2313
Mailing Address - Country:US
Mailing Address - Phone:206-624-3590
Mailing Address - Fax:206-583-4139
Practice Address - Street 1:1409 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2313
Practice Address - Country:US
Practice Address - Phone:206-624-3590
Practice Address - Fax:206-583-4139
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151865OtherL & I NUMBER
WA0151865OtherL & I NUMBER
WAU84539Medicare UPIN