Provider Demographics
NPI:1205444098
Name:WUTTKE, CHRISTOPHER Y (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:Y
Last Name:WUTTKE
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 1:1744 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1708
Mailing Address - Country:US
Mailing Address - Phone:908-427-5233
Mailing Address - Fax:732-813-1565
Practice Address - Street 1:1744 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1708
Practice Address - Country:US
Practice Address - Phone:908-427-5233
Practice Address - Fax:732-813-1565
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00768800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty