Provider Demographics
NPI:1073679569
Name:HUTTER, EDWARD E (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:HUTTER
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 1:1353 GOLD STAR HWY
Mailing Address - Street 2:STE 106
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2755
Mailing Address - Country:US
Mailing Address - Phone:860-572-1046
Mailing Address - Fax:860-536-1472
Practice Address - Street 1:1353 GOLD STAR HWY
Practice Address - Street 2:STE 106
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2755
Practice Address - Country:US
Practice Address - Phone:860-326-5869
Practice Address - Fax:860-326-5728
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350000539Medicare ID - Type Unspecified
T92562Medicare UPIN