Provider Demographics
NPI:1083776124
Name:RICHARD BUTYKOS DC, INC.
Entity Type:Organization
Organization Name:RICHARD BUTYKOS DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTYKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-278-4420
Mailing Address - Street 1:19200 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-3203
Mailing Address - Country:US
Mailing Address - Phone:313-278-4420
Mailing Address - Fax:313-563-1300
Practice Address - Street 1:19200 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48125-3203
Practice Address - Country:US
Practice Address - Phone:313-278-4420
Practice Address - Fax:313-563-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OH251240OtherBCBS
MIDR820008OtherMCARE
MIT97308Medicare UPIN
MI95OH251240OtherBCBS