Provider Demographics
NPI:1649277609
Name:RUSNAK, ASHLEY BROOK (DC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOK
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:BROOK
Other - Last Name:TESSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:19655 1ST AVE S
Mailing Address - Street 2:#205
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2166
Mailing Address - Country:US
Mailing Address - Phone:206-429-2922
Mailing Address - Fax:206-429-2422
Practice Address - Street 1:19655 1ST AVE S
Practice Address - Street 2:#205
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2166
Practice Address - Country:US
Practice Address - Phone:206-429-2922
Practice Address - Fax:206-429-2422
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8870637Medicare PIN