Provider Demographics
NPI:1194795682
Name:RATUSNY, JOHN THOMAS (DC, CCEP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:RATUSNY
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 GREYROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:703-060-3172
Mailing Address - Fax:
Practice Address - Street 1:1830 DESTINY LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1088
Practice Address - Country:US
Practice Address - Phone:703-060-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14207111N00000X
IN08003175A111N00000X
KY248960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000609620OtherANTHEM GROUP
KY000000304894OtherANTHEM
KY85002806Medicaid
KYU96853Medicare UPIN