Provider Demographics
NPI:1144491440
Name:RUSKIN, LES D (DC)
Entity type:Individual
Prefix:
First Name:LES
Middle Name:D
Last Name:RUSKIN
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 1:3488 E LAKE RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2404
Mailing Address - Country:US
Mailing Address - Phone:727-785-2545
Mailing Address - Fax:727-781-0617
Practice Address - Street 1:3488 E LAKE RD STE 102B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2404
Practice Address - Country:US
Practice Address - Phone:727-785-2545
Practice Address - Fax:727-781-0617
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT98838Medicare UPIN
FL22482Medicare PIN