Provider Demographics
NPI:1861613317
Name:JUTIS, ALEXANDER C (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:JUTIS
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 1:2855 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 760 318
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3563
Mailing Address - Country:US
Mailing Address - Phone:678-546-0550
Mailing Address - Fax:
Practice Address - Street 1:2850 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2954
Practice Address - Country:US
Practice Address - Phone:678-546-0550
Practice Address - Fax:678-546-6885
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06867111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation