Provider Demographics
NPI:1073650776
Name:BUTLER, BRADFORD THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:THOMAS
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 1:340 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2711
Mailing Address - Country:US
Mailing Address - Phone:201-651-9100
Mailing Address - Fax:201-651-1142
Practice Address - Street 1:350 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2702
Practice Address - Country:US
Practice Address - Phone:201-651-9100
Practice Address - Fax:201-651-1142
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00482500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP932119OtherOXFORD
NJ0005202515OtherAETNA
NJ202131675OtherBLUE CROSSSHIELD
NJP932119OtherOXFORD