Healthcare Provider Details

I. General information

NPI: 1750502993
Provider Name (Legal Business Name): DAVID RUTHER CHINESE MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 PLAZA DEL SUR DR # A
SANTA FE NM
87505-6043
US

IV. Provider business mailing address

1892 PLAZA DEL SUR DR # A
SANTA FE NM
87505-6043
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8017
  • Fax:
Mailing address:
  • Phone: 505-988-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1314
License Number StateNM

VIII. Authorized Official

Name: MARGARET CONNERLY
Title or Position: MANAGER
Credential:
Phone: 505-988-8017