Provider Demographics
NPI:1073540050
Name:RUTENBERG, JOAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:L
Last Name:RUTENBERG
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 1:7035 BERACASA WAY
Mailing Address - Street 2:#104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3405
Mailing Address - Country:US
Mailing Address - Phone:610-212-8700
Mailing Address - Fax:516-447-4556
Practice Address - Street 1:701 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5103
Practice Address - Country:US
Practice Address - Phone:610-212-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002439-L111N00000X
FLCH 8779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA194396Medicare ID - Type Unspecified