Provider Demographics
NPI:1003137977
Name:SUTTON, JOANNA RAE (DC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:RAE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 W ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1536
Mailing Address - Country:US
Mailing Address - Phone:541-667-2555
Mailing Address - Fax:541-564-4599
Practice Address - Street 1:935 W ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1536
Practice Address - Country:US
Practice Address - Phone:541-667-2555
Practice Address - Fax:541-564-4599
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4025111N00000X
PADC010260111N00000X
PAAJ010061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor