Provider Demographics
NPI:1861763633
Name:HUTSELL CHIROPRACTIC PC
Entity type:Organization
Organization Name:HUTSELL CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-773-4423
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1621
Mailing Address - Country:US
Mailing Address - Phone:574-773-4423
Mailing Address - Fax:574-773-2467
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1621
Practice Address - Country:US
Practice Address - Phone:574-773-4423
Practice Address - Fax:574-773-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty