Provider Demographics
NPI:1518296227
Name:RUTKOSKI, ALISSA A (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:A
Last Name:RUTKOSKI
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 1:3503 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4912
Mailing Address - Country:US
Mailing Address - Phone:619-501-7873
Mailing Address - Fax:619-501-7883
Practice Address - Street 1:3503 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4912
Practice Address - Country:US
Practice Address - Phone:619-501-7873
Practice Address - Fax:619-501-7883
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor