Healthcare Provider Details

I. General information

NPI: 1871330050
Provider Name (Legal Business Name): HAYDEN NICHOLAS KUTRIEB DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 CRAWFORDSVILLE RD STE 102
INDIANAPOLIS IN
46224-3710
US

IV. Provider business mailing address

90 EXECUTIVE DR STE E2
CARMEL IN
46032-2611
US

V. Phone/Fax

Practice location:
  • Phone: 317-957-2070
  • Fax:
Mailing address:
  • Phone: 812-887-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003463A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: