Provider Demographics
NPI:1235460619
Name:BOB HUTCHINSON PA
Entity Type:Organization
Organization Name:BOB HUTCHINSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-264-3966
Mailing Address - Street 1:1413 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4527
Mailing Address - Country:US
Mailing Address - Phone:904-264-9366
Mailing Address - Fax:904-278-7171
Practice Address - Street 1:1413 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4527
Practice Address - Country:US
Practice Address - Phone:904-264-9366
Practice Address - Fax:904-278-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050196400Medicaid
FL050196400Medicaid