Healthcare Provider Details

I. General information

NPI: 1043354145
Provider Name (Legal Business Name): WILLIAM E. TUTTLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. WILLIAM E. TUTTLE

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 E. US 40 HWY STE K
INDEPENDENCE MO
64055
US

IV. Provider business mailing address

12500 E. U.S. 40 HIGHWAY SUITE K
INDEPENDENCE MO
64055
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-5800
  • Fax:
Mailing address:
  • Phone: 816-373-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number004581
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: