Provider Demographics
NPI:1710007919
Name:RUTHERFORD, LEONARD GRANT (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:GRANT
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 1:141 E 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4006
Mailing Address - Country:US
Mailing Address - Phone:541-343-1011
Mailing Address - Fax:541-343-1011
Practice Address - Street 1:141 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4006
Practice Address - Country:US
Practice Address - Phone:541-343-1011
Practice Address - Fax:541-343-1011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR103505OtherPTAN
OR103505OtherPTAN
OR103505Medicare PIN