Provider Demographics
NPI:1558907352
Name:SUTTON, MICAH JANE (DC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:JANE
Last Name:SUTTON
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 1:1014 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1529
Mailing Address - Country:US
Mailing Address - Phone:303-620-6418
Mailing Address - Fax:
Practice Address - Street 1:1014 ADAMS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1529
Practice Address - Country:US
Practice Address - Phone:303-620-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor