Healthcare Provider Details

I. General information

NPI: 1992069389
Provider Name (Legal Business Name): JONATHAN A HUTTI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LINCOLN AVE STE 2
CHARLESTON IL
61920-2461
US

IV. Provider business mailing address

655 W LINCOLN AVE STE 2
CHARLESTON IL
61920-2461
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 Number038012194
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: