Provider Demographics
NPI:1598765281
Name:HUTTI, STEPHEN L (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:HUTTI
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 1:655 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2461
Mailing Address - Country:US
Mailing Address - Phone:217-348-1450
Mailing Address - Fax:217-348-1451
Practice Address - Street 1:655 W LINCOLN AVE
Practice Address - Street 2:STE 2
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2426
Practice Address - Country:US
Practice Address - Phone:217-348-1450
Practice Address - Fax:217-348-1451
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL397090OtherMEDICARE GROUP #
IL397090OtherMEDICARE GROUP #
ILT37241Medicare UPIN