Provider Demographics
NPI:1730443789
Name:BUTCH, PHILLIP SANTE (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SANTE
Last Name:BUTCH
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 1:514 W BANKHEAD HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1737
Mailing Address - Country:US
Mailing Address - Phone:770-459-0035
Mailing Address - Fax:
Practice Address - Street 1:514 W BANKHEAD HWY STE 300
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1737
Practice Address - Country:US
Practice Address - Phone:330-296-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4267111N00000X
GACHIR009398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor