Provider Demographics
NPI:1154429447
Name:SUTILA, MICHAEL J (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SUTILA
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 1:4B CHRISTOPHER COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7352
Mailing Address - Country:US
Mailing Address - Phone:203-790-9563
Mailing Address - Fax:203-778-6612
Practice Address - Street 1:4B CHRISTOPHER COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7352
Practice Address - Country:US
Practice Address - Phone:203-790-9563
Practice Address - Fax:203-778-6612
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor