=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831464296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGER MARC RUTZ L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 03/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 381 N YORK ST SUITES 1 AND 2
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-479-0314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 381 N YORK ST SUITES 1 AND 2
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-479-0314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 198.001012
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------