MEDICARE: ROBERT RUTKOWSKI DCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038005828	IL

General Provider Information

NPI Number	:	1497025068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT RUTKOWSKI DCPC

Provider Business Mailing Address
First Line	:	8528 GRAND AVE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1437
Country	:	US
Telephone Number	:	708-456-6212
Fax Number	:	708-456-9201

Provider Business Practice Location Address
First Line	:	8528 GRAND AVE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1437
Country	:	US
Telephone Number	:	708-456-6212
Fax Number	:	708-456-9201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT RUTKOWSKI
Credential	:	DC
Telephone Number	:	708-456-6212

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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