Provider Demographics
NPI:1952573586
Name:TUTTLE, JUSTIN CHANEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHANEY
Last Name:TUTTLE
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 1:6808 N. KNOXVILLE AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-693-9200
Mailing Address - Fax:
Practice Address - Street 1:6808 N. KNOXVILLE AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-693-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7232203OtherBLUE CROSS BLUE SHIELD
ILK51113Medicare UPIN