Provider Demographics
NPI:1669488458
Name:TUTAK, DEAN RICHARD (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RICHARD
Last Name:TUTAK
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 FLORENCE AVE.
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:586-298-6169
Mailing Address - Fax:586-298-6154
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:48066-6600
Practice Address - Country:US
Practice Address - Phone:586-298-6169
Practice Address - Fax:586-298-6154
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDT002687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E051010OtherBLUE CROSS BLUE SHIELD
MI950E051010OtherBLUE CROSS BLUE SHIELD