Provider Demographics
NPI:1508993734
Name:SUTTER, MICHAEL ELLIOT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIOT
Last Name:SUTTER
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 1:1655 LAFAYETTE ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1500
Mailing Address - Country:US
Mailing Address - Phone:303-813-1010
Mailing Address - Fax:303-830-0969
Practice Address - Street 1:1655 LAFAYETTE ST
Practice Address - Street 2:SUITE 303
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1500
Practice Address - Country:US
Practice Address - Phone:303-813-1010
Practice Address - Fax:303-830-0969
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8772104083OtherBCBS PIN NUMBER
CO11534579OtherCAQH ID
CO803061Medicare ID - Type UnspecifiedID MEDICARE
COV06399Medicare UPIN