MEDICARE: DR. TROY HOUSTON RUTLEDGE DC

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	5518	NC

General Provider Information

NPI Number	:	1528792157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY HOUSTON RUTLEDGE DC

Provider Business Mailing Address
First Line	:	624 TYVOLA RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3585
Country	:	US
Telephone Number	:	704-770-8436
Fax Number	:	704-900-8222

Provider Business Practice Location Address
First Line	:	624 TYVOLA RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3585
Country	:	US
Telephone Number	:	704-770-8436
Fax Number	:	704-900-8222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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