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General NPI Number Information
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NPI Number | 1922455161
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Entity Type | Organization
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Legal Business Name | MARK RUTHERFORD DC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 11120 GRAVELLY LAKE DR SW SUITE 10
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City | LAKEWOOD
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State | WA
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Zip | 98499-1351
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Country | US
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Telephone | 253-584-4556
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Fax |
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Provider Business Mailing Address
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Address Line | 11120 GRAVELLY LAKE DR SW SUITE 10
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City | LAKEWOOD
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State | WA
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Zip | 98499-1337
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Country | US
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Telephone | 253-584-4556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK DEAN RUTHERFORD
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Credential | DC
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Telephone | 253-584-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CH00002419
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License Number State | WA
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