Provider Demographics
NPI:1982765780
Name:TUTTLE, KATE ELLEN (DC)
Entity Type:Individual
Prefix:MISS
First Name:KATE
Middle Name:ELLEN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5972
Mailing Address - Country:US
Mailing Address - Phone:317-522-2303
Mailing Address - Fax:317-522-2304
Practice Address - Street 1:7015 S KENTUCKY AVE STE 109
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9304
Practice Address - Country:US
Practice Address - Phone:317-856-4800
Practice Address - Fax:317-856-6215
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002303A111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000556459OtherBLUE CROSS
INP00470037OtherMEDICARE RAILROAD NUMBER
IN248280HMedicare PIN