Provider Demographics
NPI:1437115748
Name:GUTZMER, BRIDGET A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:A
Last Name:GUTZMER
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 1:402 E SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6913
Mailing Address - Country:US
Mailing Address - Phone:704-405-7000
Mailing Address - Fax:704-405-7001
Practice Address - Street 1:402 E SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6913
Practice Address - Country:US
Practice Address - Phone:704-405-7000
Practice Address - Fax:704-405-7001
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH3051111N00000X
NC4358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH489Medicaid
SC203191494OtherCHIROPRACTIC
SCV041120Medicare UPIN
SCGCH489Medicaid
SC203191494OtherCHIROPRACTIC