Provider Demographics
NPI:1326192790
Name:BUTLER, JEFFERY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:A
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 1:1000 W 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2261
Mailing Address - Country:US
Mailing Address - Phone:515-961-8114
Mailing Address - Fax:515-961-8114
Practice Address - Street 1:1000 W 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2261
Practice Address - Country:US
Practice Address - Phone:515-961-8114
Practice Address - Fax:515-961-8114
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
21408Medicare ID - Type Unspecified