1649277609 NPI number — DR. ASHLEY BROOK RUSNAK DC

Table of content: DR. ASHLEY BROOK RUSNAK DC (NPI 1649277609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649277609 NPI number — DR. ASHLEY BROOK RUSNAK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSNAK
Provider First Name:
ASHLEY
Provider Middle Name:
BROOK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TESSIER
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
BROOK
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649277609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19655 1ST AVE S
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
NORMANDY PARK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98148-2166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-429-2922
Provider Business Mailing Address Fax Number:
206-429-2422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19655 1ST AVE S
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
NORMANDY PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-429-2922
Provider Business Practice Location Address Fax Number:
206-429-2422
Provider Enumeration Date:
07/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034734 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)