Provider Demographics
NPI:1497967707
Name:RUTKOWSKI, MORRIS E (DC)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:E
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MORRIS
Other - Middle Name:R
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PMB 287 PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-623-8116
Mailing Address - Fax:
Practice Address - Street 1:CARR.#2 KM.55.1
Practice Address - Street 2:BO PALENQUE
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-623-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor