Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 980DC | AZ |
NPI | 1033246327 |
---|---|
Provider Name | Mr. Lucas Andres Ruiz |
First Address | Phoenix, AZ 85006 |
Second Address | Phoenix, AZ 85006-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |