Provider Demographics
NPI:1609995836
Name:SUTTON, DANETTE (DC)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
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 1:604 CENTENNIAL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6008
Mailing Address - Country:US
Mailing Address - Phone:831-438-1300
Mailing Address - Fax:831-425-4807
Practice Address - Street 1:604 CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6008
Practice Address - Country:US
Practice Address - Phone:831-438-1300
Practice Address - Fax:831-425-4807
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0168940Medicare UPIN