Provider Demographics
NPI:1174285811
Name:BUTZIN CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:BUTZIN CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATOSHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-268-8882
Mailing Address - Street 1:57540 STONEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3168
Mailing Address - Country:US
Mailing Address - Phone:586-268-8882
Mailing Address - Fax:
Practice Address - Street 1:2050 CHESLEY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4818
Practice Address - Country:US
Practice Address - Phone:586-268-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2134015Medicaid