Healthcare Provider Details

I. General information

NPI: 1033119185
Provider Name (Legal Business Name): STEPHEN L. HUTTI & MARK E. HUTTI PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LINCOLN AVE SUITE 2
CHARLESTON IL
61920-2426
US

IV. Provider business mailing address

655 W LINCOLN AVE SUITE 2
CHARLESTON IL
61920-2426
US

V. Phone/Fax

Practice location:
  • Phone: 217-348-1450
  • Fax: 217-348-1451
Mailing address:
  • Phone: 217-348-1450
  • Fax: 217-348-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038003918/038004010
License Number StateIL

VIII. Authorized Official

Name: DR. STEPHEN L HUTTI
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 217-348-1450