Provider Demographics
NPI:1013074392
Name:FIUTEK, KACPER (DC)
Entity Type:Individual
Prefix:DR
First Name:KACPER
Middle Name:
Last Name:FIUTEK
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 1:3500 COMANCHE RD NE
Mailing Address - Street 2:SUITE I
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4546
Mailing Address - Country:US
Mailing Address - Phone:505-884-0771
Mailing Address - Fax:505-884-0776
Practice Address - Street 1:3500 COMANCHE RD NE
Practice Address - Street 2:SUITE I
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-884-0771
Practice Address - Fax:505-884-0776
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU94510Medicare UPIN
X5Q221Medicare ID - Type Unspecified