Provider Demographics
NPI:1376644237
Name:MUTTER, DONNA M (DC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:MUTTER
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 1:309 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-244-5008
Mailing Address - Fax:732-244-5562
Practice Address - Street 1:309 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-244-5008
Practice Address - Fax:732-244-5562
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMU536565Medicare ID - Type Unspecified