MEDICARE: MUTTER FAMILY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3143	MA

General Provider Information

NPI Number	:	1346567559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUTTER FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1175
Country	:	US
Telephone Number	:	781-233-7110
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1175
Country	:	US
Telephone Number	:	781-233-7110
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ANDREW J MUTTER
Credential	:	D.C.
Telephone Number	:	978-394-7428

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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