Provider Demographics
NPI:1366719619
Name:UTTER, RONALD JACK TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JACK TRAVIS
Last Name:UTTER
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 1:448 BROWN PELICAN DR.
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119
Mailing Address - Country:US
Mailing Address - Phone:407-509-1414
Mailing Address - Fax:
Practice Address - Street 1:2922 HOWLAND BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2900
Practice Address - Country:US
Practice Address - Phone:813-900-7246
Practice Address - Fax:813-409-2180
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor