Provider Demographics
NPI:1760846695
Name:CUTLER, ELLEN WAGNER (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:WAGNER
Last Name:CUTLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E BLITHEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2024
Mailing Address - Country:US
Mailing Address - Phone:415-302-6989
Mailing Address - Fax:415-384-0199
Practice Address - Street 1:116 E BLITHEDALE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2024
Practice Address - Country:US
Practice Address - Phone:415-302-6989
Practice Address - Fax:415-384-0199
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12647111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition