Provider Demographics
NPI:1104941228
Name:SUTTON, KEVIN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:SUTTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 NW 34TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1154
Mailing Address - Country:US
Mailing Address - Phone:352-377-2255
Mailing Address - Fax:352-377-5233
Practice Address - Street 1:5270 NW 34TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1154
Practice Address - Country:US
Practice Address - Phone:352-377-2255
Practice Address - Fax:352-377-5233
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008698111N00000X
FLCH11827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G910190OtherBLUE CROSS BLUE SHIELD
MI950G910190OtherBLUE CROSS BLUE SHIELD