Provider Demographics
NPI:1558309252
Name:KUTY, JOLENE N (DC)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:N
Last Name:KUTY
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 1:6634 E ASTER DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-945-7800
Mailing Address - Fax:480-945-7805
Practice Address - Street 1:6634 E ASTER DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-945-7800
Practice Address - Fax:480-945-7805
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7653111NI0900X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112346OtherMEDICARE ID-PIN
AZ751810Medicaid
AZZ112345OtherGROUP PIN
2112345Medicare PIN
AZZ112345OtherGROUP PIN
V10871Medicare UPIN
AZZ112346OtherMEDICARE ID-PIN