Provider Demographics
NPI:1962444075
Name:TUTHILL, PAUL RANDOLPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RANDOLPH
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 1:1425 BRIDGE NW
Mailing Address - Street 2:SUITE # 501
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504
Mailing Address - Country:US
Mailing Address - Phone:616-884-8644
Mailing Address - Fax:
Practice Address - Street 1:1425 BRIDGE ST NW
Practice Address - Street 2:SUITE # 501
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-1702
Practice Address - Country:US
Practice Address - Phone:616-866-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPT002903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2870924Medicaid
MI0D15090Medicare ID - Type Unspecified