Provider Demographics
NPI:1457626731
Name:RUTKOWSKI FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:RUTKOWSKI FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-673-5400
Mailing Address - Street 1:1592 GRAND ARMY HWY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1210
Mailing Address - Country:US
Mailing Address - Phone:508-673-5400
Mailing Address - Fax:508-673-6336
Practice Address - Street 1:1592 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1210
Practice Address - Country:US
Practice Address - Phone:508-673-5400
Practice Address - Fax:508-673-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 1804261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36286Medicare PIN