Provider Demographics
NPI:1427145200
Name:RUZILA, PAUL (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RUZILA
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 1:850 S WABASH AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3641
Mailing Address - Country:US
Mailing Address - Phone:312-212-1150
Mailing Address - Fax:312-212-1160
Practice Address - Street 1:850 S WABASH AVE
Practice Address - Street 2:STE 290
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3641
Practice Address - Country:US
Practice Address - Phone:312-212-1150
Practice Address - Fax:312-212-1160
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634259OtherBLUE CROSS BLUE SHIELD IL
ILK07244Medicare PIN
IL01634259OtherBLUE CROSS BLUE SHIELD IL