Healthcare Provider Details

I. General information

NPI: 1588167878
Provider Name (Legal Business Name): JOSEPH C. HUTCHINSON JR. BCTMB, CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LIGHTHOUSE AVE. (#104) CA SUITE # 104
PACIFIC GROVE CA
93950
US

IV. Provider business mailing address

505 LIGHTHOUSE AVE. (#104) SUITE 104
PACIFIC GROVE CA
93950
US

V. Phone/Fax

Practice location:
  • Phone: 831-214-3167
  • Fax:
Mailing address:
  • Phone: 831-214-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCAMTC-35847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: