Provider Demographics
NPI:1629180591
Name:RUGG, LAWRENCE M (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:RUGG
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 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-530-4500
Mailing Address - Fax:630-833-9680
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 315
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-530-4500
Practice Address - Fax:630-833-9680
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06095Medicare ID - Type Unspecified
ILU77937Medicare UPIN