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General NPI Number Information
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NPI Number | 1982196952
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Entity Type | Organization
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Legal Business Name | EVAN RUTERBORIES DC PC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 4281 SERGEANT RD
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City | SIOUX CITY
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State | IA
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Zip | 51106-4625
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Country | US
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Telephone | 712-221-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 4281 SERGEANT RD
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City | SIOUX CITY
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State | IA
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Zip | 51106-4625
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Country | US
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Telephone | 712-221-2666
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. EVAN RUTERBORIES
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Credential | DC
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Telephone | 712-221-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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