Provider Demographics
NPI:1699822973
Name:SUTTON CHIROPRACTIC AND MASSAGE PS
Entity Type:Organization
Organization Name:SUTTON CHIROPRACTIC AND MASSAGE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-923-5588
Mailing Address - Street 1:1518 BISHOP RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7354
Mailing Address - Country:US
Mailing Address - Phone:360-923-5588
Mailing Address - Fax:360-915-9815
Practice Address - Street 1:1518 BISHOP RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7354
Practice Address - Country:US
Practice Address - Phone:360-923-5588
Practice Address - Fax:360-915-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG11500076OtherMEDICARE PTAN
WAG11500076OtherMEDICARE PTAN