Provider Demographics
NPI:1619029543
Name:HUTNIK, GEORGE MICHAEL IV (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:HUTNIK
Suffix:IV
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 1:133 DONOHOE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7921
Mailing Address - Country:US
Mailing Address - Phone:724-838-8133
Mailing Address - Fax:724-838-8119
Practice Address - Street 1:133 DONOHOE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7921
Practice Address - Country:US
Practice Address - Phone:724-838-8133
Practice Address - Fax:724-838-8119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119494Medicare PIN