Provider Demographics
NPI:1376918102
Name:STUTTGEN, ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STUTTGEN
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 1:100 N 72ND AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9042
Mailing Address - Country:US
Mailing Address - Phone:715-470-5671
Mailing Address - Fax:
Practice Address - Street 1:100 N 72ND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-9042
Practice Address - Country:US
Practice Address - Phone:715-470-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5141-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor