Provider Demographics
NPI:1710995592
Name:HUTTO, DAWN MATEE (DC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MATEE
Last Name:HUTTO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:FABER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:420 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3620
Mailing Address - Country:US
Mailing Address - Phone:803-202-0202
Mailing Address - Fax:803-202-0201
Practice Address - Street 1:420 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3620
Practice Address - Country:US
Practice Address - Phone:803-202-0202
Practice Address - Fax:803-202-0201
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00214046Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SC97073Medicare UPIN