Provider Demographics
NPI:1871691998
Name:RUGGIERO, BRIAN STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:STEPHEN
Last Name:RUGGIERO
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 1:1047 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6013
Mailing Address - Country:US
Mailing Address - Phone:860-643-2888
Mailing Address - Fax:
Practice Address - Street 1:1047 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6013
Practice Address - Country:US
Practice Address - Phone:860-643-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007548111N00000X
CT1454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor