Provider Demographics
NPI:1316322282
Name:MUTTER, DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:MUTTER
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 1:3810 SE DIVISION ST STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1678
Mailing Address - Country:US
Mailing Address - Phone:971-645-7576
Mailing Address - Fax:971-999-7027
Practice Address - Street 1:3810 SE DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1678
Practice Address - Country:US
Practice Address - Phone:971-645-7576
Practice Address - Fax:971-999-7027
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32888111N00000X
NJ38MC00710400111N00000X
OR5727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor