Provider Demographics
NPI:1932385580
Name:TUTTLE, DANIEL (DC, LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:DC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 TAMPA RD STE H
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3130
Mailing Address - Country:US
Mailing Address - Phone:727-509-3760
Mailing Address - Fax:
Practice Address - Street 1:2595 TAMPA RD STE H
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-509-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL145641041C0700X
MELC114541041C0700X
GACSW0041311041C0700X
FL12257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA428288946CMedicaid
ME432058399Medicaid
GAVX0090OtherMEDICARE PTAN