Provider Demographics
NPI:1730244658
Name:RUZICKA, ANDREA JOY (BS, DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JOY
Last Name:RUZICKA
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 E SHOMI ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3850
Mailing Address - Country:US
Mailing Address - Phone:480-785-5150
Mailing Address - Fax:480-829-9593
Practice Address - Street 1:930 W BROADWAY RD STE 7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1269
Practice Address - Country:US
Practice Address - Phone:480-829-9593
Practice Address - Fax:480-829-9594
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5938111N00000X
AZ3541111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU86991Medicare UPIN
AZ67288Medicare ID - Type Unspecified