Provider Demographics
NPI:1770659286
Name:HUTCHINS, GRANT WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:WARREN
Last Name:HUTCHINS
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 1:990 HILLCREST ST
Mailing Address - Street 2:#105
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-9248
Mailing Address - Country:US
Mailing Address - Phone:715-684-2494
Mailing Address - Fax:
Practice Address - Street 1:990 HILLCREST ST
Practice Address - Street 2:#105
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9248
Practice Address - Country:US
Practice Address - Phone:715-684-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38834300Medicaid
WI38834300Medicaid