Provider Demographics
NPI:1679938559
Name:RUTZ, JORDAN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:RUTZ
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 1:716 HOWE AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5124
Mailing Address - Country:US
Mailing Address - Phone:330-836-3333
Mailing Address - Fax:330-836-3335
Practice Address - Street 1:716 HOWE AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5124
Practice Address - Country:US
Practice Address - Phone:330-836-3333
Practice Address - Fax:330-836-3335
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4579111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition