Provider Demographics
NPI:1184727992
Name:HITCHINER, JOHN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:HITCHINER
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035
Mailing Address - Country:US
Mailing Address - Phone:860-653-5581
Mailing Address - Fax:860-653-6035
Practice Address - Street 1:50 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035
Practice Address - Country:US
Practice Address - Phone:860-653-5581
Practice Address - Fax:860-653-6035
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004130887Medicaid
CT050001024CT02OtherANTHEM BLUE CROSS BLUE SH
CT350000749Medicare ID - Type Unspecified
CT004130887Medicaid