Healthcare Provider Details

I. General information

NPI: 1588020499
Provider Name (Legal Business Name): MISTY RHIANNON HUTTON DC, MAOM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 10/05/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25268 CA-18
CRESTLINE CA
92325
US

IV. Provider business mailing address

PO BOX 1831
CRESTLINE CA
92325-1831
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-6477
  • Fax:
Mailing address:
  • Phone: 909-338-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 4551; LAC-829
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number33114
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33114
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: