Provider Demographics
NPI:1437261757
Name:RUTHERFORD, JEFFREY D (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:RUTHERFORD
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 1:11 FOUR WINDS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1134
Mailing Address - Country:US
Mailing Address - Phone:314-426-4424
Mailing Address - Fax:314-890-2410
Practice Address - Street 1:10035 PAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1432
Practice Address - Country:US
Practice Address - Phone:314-426-4424
Practice Address - Fax:314-890-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4400266OtherUNITED HEALTHCARE
MO157639OtherBLUE CROSS PIN
MO481262OtherHEALTHLINK PIN
MO4400266OtherUNITED HEALTHCARE
MO000031764Medicare PIN