Provider Demographics
NPI:1700325305
Name:DUTRUCH, AARON C (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:C
Last Name:DUTRUCH
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 1:1120 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3429
Mailing Address - Country:US
Mailing Address - Phone:985-674-5855
Mailing Address - Fax:985-674-5854
Practice Address - Street 1:1120 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3429
Practice Address - Country:US
Practice Address - Phone:985-674-5855
Practice Address - Fax:985-674-5854
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor