Provider Demographics
NPI:1083758569
Name:SUTLIFF, BETTY B (DC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:B
Last Name:SUTLIFF
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 1:1983 STATE ROAD 602
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7216
Mailing Address - Country:US
Mailing Address - Phone:505-722-7575
Mailing Address - Fax:866-856-0852
Practice Address - Street 1:1983 STATE ROAD 602
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-7216
Practice Address - Country:US
Practice Address - Phone:505-722-7575
Practice Address - Fax:866-856-0852
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5417111N00000X
NM1382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938150OtherBLUE CROSS BLUE SHIELD
AZAZ0240821OtherBLUE CROSS BLUE SHIELD
AZAZ0938150OtherBLUE CROSS BLUE SHIELD