Provider Demographics
NPI:1700377892
Name:RUTHERFORD, MARK D (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4916 CENTER ST
Mailing Address - Street 2:STE G
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2348
Mailing Address - Country:US
Mailing Address - Phone:253-912-9653
Mailing Address - Fax:253-912-9660
Practice Address - Street 1:11122 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1348
Practice Address - Country:US
Practice Address - Phone:253-355-8156
Practice Address - Fax:206-923-7601
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922455161OtherNPI