MEDICARE: DR. DEAN RICHARD TUTAK CHIROPRACTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DT002687	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950E051010	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669488458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN RICHARD TUTAK CHIROPRACTOR

Provider Business Mailing Address
First Line	:	18600 FLORENCE AVE.
Second Line	:	SUITE B5
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-0066
Country	:	US
Telephone Number	:	586-298-6169
Fax Number	:	586-298-6154

Provider Business Practice Location Address
First Line	:	18600 FLORENCE ST
Second Line	:	SUITE B5
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	586-298-6169
Fax Number	:	586-298-6154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/30/2010

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