Provider Demographics
NPI:1629068580
Name:HUTSON, TERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:HUTSON
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:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-0825
Mailing Address - Country:US
Mailing Address - Phone:870-356-2019
Mailing Address - Fax:870-356-2070
Practice Address - Street 1:400 E BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9247
Practice Address - Country:US
Practice Address - Phone:870-356-2019
Practice Address - Fax:870-356-2070
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C829Medicare ID - Type Unspecified