Provider Demographics
NPI:1790143287
Name:NUTTER, KENNETH PAUL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:NUTTER
Suffix:JR
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 1:102 E REDOUBT AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8012
Mailing Address - Country:US
Mailing Address - Phone:907-262-9117
Mailing Address - Fax:
Practice Address - Street 1:102 E REDOUBT AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8012
Practice Address - Country:US
Practice Address - Phone:907-262-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor