Provider Demographics
NPI:1033101936
Name:BUTLER, LESLIE SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:SCOTT
Last Name:BUTLER
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 1:28 CROSSROADS PLZ
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6664
Mailing Address - Country:US
Mailing Address - Phone:636-294-6260
Mailing Address - Fax:636-294-0507
Practice Address - Street 1:28 CROSSROADS PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6664
Practice Address - Country:US
Practice Address - Phone:636-970-0566
Practice Address - Fax:636-970-2738
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2016-08-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MO2000164684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO190761OtherBC/BS
MO190761OtherBC/BS
MO000032186Medicare ID - Type Unspecified