Provider Demographics
NPI:1194721779
Name:STUTO, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:STUTO
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 1:112 S COUNTRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2534
Mailing Address - Country:US
Mailing Address - Phone:631-286-9410
Mailing Address - Fax:
Practice Address - Street 1:112 S COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2534
Practice Address - Country:US
Practice Address - Phone:631-286-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400004413Medicare PIN