Provider Demographics
NPI:1588020499
Name:HUTTON, MISTY RHIANNON (DC, MAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:RHIANNON
Last Name:HUTTON
Suffix:
Gender:F
Credentials:DC, MAOM, LAC
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 1831
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-1831
Mailing Address - Country:US
Mailing Address - Phone:909-338-6477
Mailing Address - Fax:
Practice Address - Street 1:25268 CA-18
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-338-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDC 4551; LAC-829111N00000X
CA33114111NN1001X, 111N00000X
CA16296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No171100000XOther Service ProvidersAcupuncturist