Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC3752-L | PA |
NPI | 1811967573 |
---|---|
Provider Name | Mary Rutkowski |
First Address | Center Valley, PA 18034-9601 |
Second Address | Center Valley, PA 18034-9601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 11/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02691000 | CBC- CHIROPRACTOR (01) | PA |
T72800 | (02) | PA |