Provider Demographics
NPI:1154309920
Name:BUTNER, LYNNE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:BUTNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:MARIE
Other - Last Name:JERTBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2801 COFFEE RD
Mailing Address - Street 2:A-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1756
Mailing Address - Country:US
Mailing Address - Phone:209-524-7796
Mailing Address - Fax:209-524-8477
Practice Address - Street 1:2801 COFFEE RD
Practice Address - Street 2:A-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1756
Practice Address - Country:US
Practice Address - Phone:209-524-7796
Practice Address - Fax:209-524-8477
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05931Medicare UPIN
DC0157780Medicare ID - Type Unspecified