Healthcare Provider Details

I. General information

NPI: 1811258528
Provider Name (Legal Business Name): RUTHERFORD CHIROPRACTIC NEUROLOGY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E MADISON ST
HOUSTON MS
38851-2321
US

IV. Provider business mailing address

332 E MADISON ST
HOUSTON MS
38851-2321
US

V. Phone/Fax

Practice location:
  • Phone: 662-448-5747
  • Fax: 662-448-5751
Mailing address:
  • Phone: 662-448-5747
  • Fax: 662-448-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1006
License Number StateMS

VIII. Authorized Official

Name: DR. JOSEPH LEE RUTHERFORD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 662-448-5747