Provider Demographics
NPI:1114463270
Name:BUTLER, BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
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 1:203 TOWNE PARK RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-1301
Mailing Address - Country:US
Mailing Address - Phone:479-601-1914
Mailing Address - Fax:
Practice Address - Street 1:203 TOWNE PARK RD UNIT E
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-1301
Practice Address - Country:US
Practice Address - Phone:479-601-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor