Provider Demographics
NPI:1588757447
Name:RUTKOWSKI, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 W. GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1437
Mailing Address - Country:US
Mailing Address - Phone:708-456-6212
Mailing Address - Fax:708-456-9201
Practice Address - Street 1:8528 W. GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1437
Practice Address - Country:US
Practice Address - Phone:708-456-6212
Practice Address - Fax:708-456-9201
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385828111N00000X
IL38-5828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01682757OtherBCBS
IL780580Medicare PIN
ILT39019Medicare UPIN
IL780580Medicare ID - Type Unspecified
T39019Medicare UPIN