Provider Demographics
NPI:1033654165
Name:HUTCHISON, KENNETH ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ERIC
Last Name:HUTCHISON
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 1:777 E THUNDERBIRD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5335
Mailing Address - Country:US
Mailing Address - Phone:602-327-1818
Mailing Address - Fax:
Practice Address - Street 1:777 E THUNDERBIRD RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5335
Practice Address - Country:US
Practice Address - Phone:602-327-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor