Provider Demographics
NPI:1093886590
Name:HUTSON-THROM, MONICA (DC)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:HUTSON-THROM
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 1:420 W WOOD STREET
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2836
Mailing Address - Country:US
Mailing Address - Phone:530-934-9500
Mailing Address - Fax:530-934-9525
Practice Address - Street 1:420 WEST WOOD STREET
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2836
Practice Address - Country:US
Practice Address - Phone:530-934-9500
Practice Address - Fax:530-934-9525
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03061Medicare UPIN