Provider Demographics
NPI:1013297217
Name:NUTTY, STEVE K (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:K
Last Name:NUTTY
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 1:46 STONEHEDGE CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-2546
Mailing Address - Country:US
Mailing Address - Phone:315-525-8770
Mailing Address - Fax:
Practice Address - Street 1:1600 MALL OF GEORGIA BLVD
Practice Address - Street 2:SUITE 1110
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8749
Practice Address - Country:US
Practice Address - Phone:315-525-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008877111N00000X
CO6699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor