Provider Demographics
NPI:1215957774
Name:GUTRICH, JANET MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MARIE
Last Name:GUTRICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1111
Mailing Address - Country:US
Mailing Address - Phone:773-472-0700
Mailing Address - Fax:773-472-0300
Practice Address - Street 1:1425 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1111
Practice Address - Country:US
Practice Address - Phone:773-472-0700
Practice Address - Fax:773-472-0300
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634073OtherBLUE CROSS BLUE SHIELD