=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750665378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANNY JOE RUTZ DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2011
-----------------------------------------------------
Last Update Date | 10/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 S. JONES BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-312-2225
-----------------------------------------------------
Fax | 702-312-2230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 S. JONES BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-312-2225
-----------------------------------------------------
Fax | 702-312-2230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANNY JOE RUTZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 702-312-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | B529
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------