=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932388717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUTTON CHIROPRACTIC HEALTH CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 11/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6116 ROLLING RD STE 304
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-644-9311
-----------------------------------------------------
Fax | 703-644-3907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6116 ROLLING RD STE 304
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-644-9311
-----------------------------------------------------
Fax | 703-644-3907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PETER VICTOR BOYER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 703-644-9311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556224
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556122
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------