Provider Demographics
NPI:1205836178
Name:BUTERA, ROSANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:
Last Name:BUTERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W 35TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1370
Mailing Address - Country:US
Mailing Address - Phone:512-323-6767
Mailing Address - Fax:512-302-0244
Practice Address - Street 1:1803 W 35TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1370
Practice Address - Country:US
Practice Address - Phone:512-323-6767
Practice Address - Fax:512-302-0244
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC03603623Medicaid
TXC03603623Medicare ID - Type Unspecified
TXC03603623Medicaid
TXTXB156441Medicare PIN