Provider Demographics
NPI:1336334697
Name:RUTTER, SADIE OLIVIA IRENE (DC)
Entity Type:Individual
Prefix:DR
First Name:SADIE
Middle Name:OLIVIA IRENE
Last Name:RUTTER
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 1:2665 NW STRATH WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8690
Mailing Address - Country:US
Mailing Address - Phone:541-312-8212
Mailing Address - Fax:541-389-5345
Practice Address - Street 1:464 NE NORTON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4387
Practice Address - Country:US
Practice Address - Phone:541-312-8212
Practice Address - Fax:541-389-5345
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV08463Medicare UPIN
OR134110Medicare PIN