MEDICARE: DR. STEPHEN L HUTTI D.C.

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		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	397090	OTHER	IL	MEDICARE GROUP #

General Provider Information

NPI Number	:	1598765281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN L HUTTI D.C.

Provider Business Mailing Address
First Line	:	655 W LINCOLN AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2461
Country	:	US
Telephone Number	:	217-348-1450
Fax Number	:	217-348-1451

Provider Business Practice Location Address
First Line	:	655 W LINCOLN AVE
Second Line	:	STE 2
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2426
Country	:	US
Telephone Number	:	217-348-1450
Fax Number	:	217-348-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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