Provider Demographics
NPI:1629154968
Name:RUTHERFORD, JOSEPH LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE
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 1:332 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2321
Mailing Address - Country:US
Mailing Address - Phone:662-448-5747
Mailing Address - Fax:662-448-5751
Practice Address - Street 1:332 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2321
Practice Address - Country:US
Practice Address - Phone:662-448-5747
Practice Address - Fax:662-448-5751
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123827Medicaid
MS00123827Medicaid
350000318Medicare ID - Type Unspecified