Provider Demographics
NPI:1043598436
Name:RUTHERFORD, MARY E (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PRIOR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5163
Mailing Address - Country:US
Mailing Address - Phone:651-917-3990
Mailing Address - Fax:651-917-3922
Practice Address - Street 1:245 PRIOR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5163
Practice Address - Country:US
Practice Address - Phone:651-917-3990
Practice Address - Fax:651-917-3922
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor