Provider Demographics
NPI:1386254829
Name:GIUTTARI, IAN (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:GIUTTARI
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 1:1920 MINERAL SPRING AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3742
Mailing Address - Country:US
Mailing Address - Phone:401-354-5500
Mailing Address - Fax:
Practice Address - Street 1:1920 MINERAL SPRING AVE STE 16AND17
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3742
Practice Address - Country:US
Practice Address - Phone:401-354-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty