Provider Demographics
NPI:1497899454
Name:HUTSELL, MARK D (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:HUTSELL
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 1:301 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1621
Mailing Address - Country:US
Mailing Address - Phone:574-773-4423
Mailing Address - Fax:574-773-2467
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1621
Practice Address - Country:US
Practice Address - Phone:574-773-4423
Practice Address - Fax:574-773-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000964A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112890AMedicaid
IN225780Medicare ID - Type Unspecified