Provider Demographics
NPI:1255348132
Name:SUTTERLEY, EDWARD C (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:SUTTERLEY
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 1:438 CTY RD 513
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830
Mailing Address - Country:US
Mailing Address - Phone:908-832-2099
Mailing Address - Fax:908-832-6017
Practice Address - Street 1:438 CTY RD 513
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830
Practice Address - Country:US
Practice Address - Phone:908-832-2099
Practice Address - Fax:908-832-6017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00334500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ508572Medicare PIN