Healthcare Provider Details

I. General information

NPI: 1124081179
Provider Name (Legal Business Name): JILL M HUTTER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S TAMARAC DR SUITE 215
DENVER CO
80237-1419
US

IV. Provider business mailing address

3525 S TAMARAC DR SUITE 215
DENVER CO
80237-1419
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-4878
  • Fax: 303-779-4894
Mailing address:
  • Phone: 303-779-4878
  • Fax: 303-779-4894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: