Provider Demographics
NPI:1700061835
Name:BUTLER CHIROPRACTIC PC
Entity type:Organization
Organization Name:BUTLER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-548-0125
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0542
Mailing Address - Country:US
Mailing Address - Phone:541-548-0125
Mailing Address - Fax:541-548-0323
Practice Address - Street 1:340 NW 5TH ST STE 204
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-548-0125
Practice Address - Fax:541-548-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2181111N00000X
OR272181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1700016835OtherPRIVATE HEALTH INSURANCE
OR1700016835OtherPRIVATE HEALTH INSURANCE