Provider Demographics
NPI:1629214580
Name:GUTCHES CHIROPRACTIC SPORTS & WELLNESS
Entity Type:Organization
Organization Name:GUTCHES CHIROPRACTIC SPORTS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUTCHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-779-3138
Mailing Address - Street 1:3138 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8450
Mailing Address - Country:US
Mailing Address - Phone:541-779-3138
Mailing Address - Fax:888-383-7132
Practice Address - Street 1:3138 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8450
Practice Address - Country:US
Practice Address - Phone:541-779-3138
Practice Address - Fax:888-383-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3540261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center