Provider Demographics
NPI:1033119185
Name:STEPHEN L. HUTTI & MARK E. HUTTI PTR
Entity Type:Organization
Organization Name:STEPHEN L. HUTTI & MARK E. HUTTI PTR
Other - Org Name:HUTTI CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-348-1450
Mailing Address - Street 1:655 W LINCOLN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2426
Mailing Address - Country:US
Mailing Address - Phone:217-348-1450
Mailing Address - Fax:217-348-1451
Practice Address - Street 1:655 W LINCOLN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2426
Practice Address - Country:US
Practice Address - Phone:217-348-1450
Practice Address - Fax:217-348-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003918/038004010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL397090Medicare UPIN