Provider Demographics
NPI:1285722025
Name:HUETTL, MATTHEW K (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:K
Last Name:HUETTL
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 1:6634 LAKE OTIS PKWY
Mailing Address - Street 2:#A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2123
Mailing Address - Country:US
Mailing Address - Phone:907-522-3511
Mailing Address - Fax:907-522-8551
Practice Address - Street 1:6634 LAKE OTIS PKWY
Practice Address - Street 2:#A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2123
Practice Address - Country:US
Practice Address - Phone:907-522-3511
Practice Address - Fax:907-522-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCH0328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0328Medicaid
AKK151178Medicare ID - Type UnspecifiedSPORTS & SPINAL INJURY CL
AKCH0328Medicaid