Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH8717 | FL |
N | 111NN0400X | Neurology | CH8717 | FL |
NPI | 1104839471 |
---|---|
Provider Name | Dr. Martin Rukeyser |
First Address | Port Saint Lucie, FL 34952-5330 |
Second Address | Port Saint Lucie, FL 34952-5330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 18/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
381889600 | (05) | FL |