MEDICARE: DR. ROBERT RUTKOWSKI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	385828	IL
2	111N00000X	Chiropractor	38-5828	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01682757	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1588757447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT RUTKOWSKI D.C.

Provider Business Mailing Address
First Line	:	8528 W. GRAND AVENUE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1437
Country	:	US
Telephone Number	:	708-456-6212
Fax Number	:	708-456-9201

Provider Business Practice Location Address
First Line	:	8528 W. GRAND AVENUE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1437
Country	:	US
Telephone Number	:	708-456-6212
Fax Number	:	708-456-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/31/2010

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