Provider Demographics
NPI:1912053265
Name:GUTOWSKI, WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:GUTOWSKI
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 1:7426 E STETSON DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3547
Mailing Address - Country:US
Mailing Address - Phone:480-425-7100
Mailing Address - Fax:480-425-0131
Practice Address - Street 1:7426 E STETSON DR
Practice Address - Street 2:SUITE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3547
Practice Address - Country:US
Practice Address - Phone:480-425-7100
Practice Address - Fax:480-425-0131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC4707Medicare PIN