Provider Demographics
NPI:1427192616
Name:RUTZICK, JOSHUA ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ALAN
Last Name:RUTZICK
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 1:2556 BETH CT E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5523
Mailing Address - Country:US
Mailing Address - Phone:651-983-4608
Mailing Address - Fax:651-287-0935
Practice Address - Street 1:60 PLATO BLVD E
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1827
Practice Address - Country:US
Practice Address - Phone:651-287-0935
Practice Address - Fax:651-287-0936
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor