Provider Demographics
NPI:1215016282
Name:TUTEN, ALTON CHADWICK (DC)
Entity Type:Individual
Prefix:DR
First Name:ALTON
Middle Name:CHADWICK
Last Name:TUTEN
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:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39818-0933
Mailing Address - Country:US
Mailing Address - Phone:229-246-6417
Mailing Address - Fax:229-246-2041
Practice Address - Street 1:406 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-3918
Practice Address - Country:US
Practice Address - Phone:229-246-6417
Practice Address - Fax:229-246-2041
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO006256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU76314Medicare UPIN