Provider Demographics
NPI:1942206552
Name:TUTHILL, ALAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:TUTHILL
Suffix:
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 1:10201 MISSION GORGE RD
Mailing Address - Street 2:STE L
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3026
Mailing Address - Country:US
Mailing Address - Phone:619-449-8100
Mailing Address - Fax:619-258-2010
Practice Address - Street 1:10201 MISSION GORGE RD
Practice Address - Street 2:STE L
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3026
Practice Address - Country:US
Practice Address - Phone:619-449-8100
Practice Address - Fax:619-258-2010
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0169160Medicaid
DC16916Medicare ID - Type Unspecified
CADC0169160Medicaid