Provider Demographics
NPI:1750502993
Name:DAVID RUTHER CHINESE MEDICINE INC.
Entity Type:Organization
Organization Name:DAVID RUTHER CHINESE MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-988-8017
Mailing Address - Street 1:1892 PLAZA DEL SUR DR # A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6043
Mailing Address - Country:US
Mailing Address - Phone:505-988-8017
Mailing Address - Fax:
Practice Address - Street 1:1892 PLAZA DEL SUR DR # A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6043
Practice Address - Country:US
Practice Address - Phone:505-988-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty