Provider Demographics
NPI:1497780738
Name:HUTCHINSON, GARY R (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:HUTCHINSON
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 426
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0426
Mailing Address - Country:US
Mailing Address - Phone:229-244-2045
Mailing Address - Fax:229-244-5784
Practice Address - Street 1:503 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4607
Practice Address - Country:US
Practice Address - Phone:225-244-2045
Practice Address - Fax:229-244-5784
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T98064Medicare UPIN