Provider Demographics
NPI:1114101276
Name:RUTHER, SARAH JOY (DC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JOY
Last Name:RUTHER
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 1:2 ENTERPRISE AVE NE STE C1
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-6811
Mailing Address - Country:US
Mailing Address - Phone:763-444-4668
Mailing Address - Fax:763-444-7952
Practice Address - Street 1:2 ENTERPRISE AVE NE STE C1
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6811
Practice Address - Country:US
Practice Address - Phone:763-444-4668
Practice Address - Fax:763-444-7952
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004241OtherMEDICARE PTAN
MN1114101276Medicaid
MN13363885723OtherGROUP NPI