Provider Demographics
NPI:1962045724
Name:GUTIERREZ, ADRIAN (DC, MS)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6963
Mailing Address - Country:US
Mailing Address - Phone:623-440-8491
Mailing Address - Fax:
Practice Address - Street 1:1232 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6963
Practice Address - Country:US
Practice Address - Phone:623-440-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003124A111N00000X, 111NN1001X, 111NR0400X
IL038.013544111N00000X
MO2021009678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation