Provider Demographics
NPI:1932265352
Name:DAVID RUVICH
Entity Type:Organization
Organization Name:DAVID RUVICH
Other - Org Name:STOUGHTON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-341-3117
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0502
Mailing Address - Country:US
Mailing Address - Phone:781-341-3117
Mailing Address - Fax:
Practice Address - Street 1:1214 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3345
Practice Address - Country:US
Practice Address - Phone:781-341-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58336Medicare UPIN
MAY35692Medicare ID - Type Unspecified