Provider Demographics
NPI:1295741080
Name:TUTAK CHIROPRACTIC
Entity type:Organization
Organization Name:TUTAK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TUTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-771-3888
Mailing Address - Street 1:18600 FLORENCE ST.
Mailing Address - Street 2:SUITE B5
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-0066
Mailing Address - Country:US
Mailing Address - Phone:586-771-3888
Mailing Address - Fax:586-771-1595
Practice Address - Street 1:18600 FLORENCE ST.
Practice Address - Street 2:SUITE B5
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-0066
Practice Address - Country:US
Practice Address - Phone:586-771-3888
Practice Address - Fax:586-771-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDT002687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty