Provider Demographics
NPI:1265553168
Name:SUTCLIFFE, ROBERT C (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:SUTCLIFFE
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 1:424 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2091
Mailing Address - Country:US
Mailing Address - Phone:952-448-4222
Mailing Address - Fax:952-448-5393
Practice Address - Street 1:424 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2091
Practice Address - Country:US
Practice Address - Phone:952-448-4222
Practice Address - Fax:952-448-5393
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109957OtherHEALTH PARTNERS NUMBER
MN355G3SUOtherBCBS OF MN GROUP
MN4488345OtherMEDICA PROVIDER NUMBER
MN4488345OtherMEDICA PROVIDER NUMBER