Provider Demographics
NPI:1396888053
Name:KUTZ SCHIPPEL, ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:KUTZ SCHIPPEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3476
Mailing Address - Country:US
Mailing Address - Phone:217-245-9797
Mailing Address - Fax:217-245-2524
Practice Address - Street 1:1429 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3476
Practice Address - Country:US
Practice Address - Phone:217-245-9797
Practice Address - Fax:217-245-2524
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06922750OtherBLUE CROSS BLUE SHIELD