Provider Demographics
NPI:1982196952
Name:EVAN RUTERBORIES DC PC
Entity Type:Organization
Organization Name:EVAN RUTERBORIES DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTERBORIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-221-2666
Mailing Address - Street 1:4281 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4625
Mailing Address - Country:US
Mailing Address - Phone:712-221-2666
Mailing Address - Fax:
Practice Address - Street 1:4281 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4625
Practice Address - Country:US
Practice Address - Phone:712-221-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center