Provider Demographics
NPI:1700955754
Name:FOXLEY & BUTCHART MEDICAL CORPORATION
Entity type:Organization
Organization Name:FOXLEY & BUTCHART MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-487-5105
Mailing Address - Street 1:34563 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4575
Mailing Address - Country:US
Mailing Address - Phone:510-487-5105
Mailing Address - Fax:510-487-5106
Practice Address - Street 1:34563 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4575
Practice Address - Country:US
Practice Address - Phone:510-487-5105
Practice Address - Fax:510-487-5106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOXLEY & BUTCHART MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204C00000X
CAC29434208D00000X
CADC27315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC273150Medicaid
CAC29434OtherDR. MOGLEN LICENSE
CABM9073812OtherDR. MOGLEN DEA
CA00C294340Medicare ID - Type UnspecifiedDR. MOGLEN
CADC273150Medicaid
CAA33920Medicare UPIN
CADC027315Medicare ID - Type Unspecified