Provider Demographics
NPI:1225100795
Name:BUTCHER, TONY
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10863 N ROSE CT
Mailing Address - Street 2:
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-3551
Mailing Address - Country:US
Mailing Address - Phone:217-932-5171
Mailing Address - Fax:
Practice Address - Street 1:409 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420-1408
Practice Address - Country:US
Practice Address - Phone:217-932-5740
Practice Address - Fax:217-932-4988
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL641970Medicare ID - Type Unspecified
ILT37399Medicare UPIN