Provider Demographics
NPI:1669597787
Name:DR. JERRY E. HUTCHISON, LTD.
Entity type:Organization
Organization Name:DR. JERRY E. HUTCHISON, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-848-8865
Mailing Address - Street 1:836 MAPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1402
Mailing Address - Country:US
Mailing Address - Phone:708-848-8865
Mailing Address - Fax:
Practice Address - Street 1:836 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1402
Practice Address - Country:US
Practice Address - Phone:708-848-8865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623241OtherBLUE CROSS BLUE SHIELD IL
IL710470Medicare ID - Type UnspecifiedMEDICARE