Provider Demographics
NPI:1780752642
Name:TRUTTMANN, JOSEPH M (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:TRUTTMANN
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 1:7100 W MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3022
Mailing Address - Country:US
Mailing Address - Phone:618-397-6611
Mailing Address - Fax:618-397-6622
Practice Address - Street 1:7100 W MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3022
Practice Address - Country:US
Practice Address - Phone:618-397-6611
Practice Address - Fax:618-397-6622
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1704526 INACTIVE111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PINP00249134OtherRAILROAD MEDICARE
IL8282038OtherBCBS OF IL
692710Medicare ID - Type Unspecified
PINP00249134OtherRAILROAD MEDICARE