Provider Demographics
NPI:1255573168
Name:GORNEY TUTAK, VICTORIA M (DC, PSY,D)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:GORNEY TUTAK
Suffix:
Gender:F
Credentials:DC, PSY,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5724
Mailing Address - Country:US
Mailing Address - Phone:530-615-4041
Mailing Address - Fax:530-615-4043
Practice Address - Street 1:1061 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5724
Practice Address - Country:US
Practice Address - Phone:530-615-4041
Practice Address - Fax:530-615-4043
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18807111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic