Provider Demographics
NPI:1073626602
Name:RUTKOWSKI, ADAM ARNOLD (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ARNOLD
Last Name:RUTKOWSKI
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 1:22308 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123
Mailing Address - Country:US
Mailing Address - Phone:216-289-2500
Mailing Address - Fax:216-289-2585
Practice Address - Street 1:22308 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123
Practice Address - Country:US
Practice Address - Phone:216-289-2500
Practice Address - Fax:216-289-2585
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28932Medicare UPIN
OHRU0710714Medicare ID - Type Unspecified