Provider Demographics
NPI:1427008754
Name:BUTLER, RANDY WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WAYNE
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 1:1501 CROSS TIMBERS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1201
Mailing Address - Country:US
Mailing Address - Phone:972-221-7533
Mailing Address - Fax:972-219-6901
Practice Address - Street 1:1501 CROSS TIMBERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1201
Practice Address - Country:US
Practice Address - Phone:972-221-7533
Practice Address - Fax:972-219-6901
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752076527OtherTAX ID
TX4260714OtherAETNA ID
TX28102272OtherCIGNA ID
TX601265OtherBLUE CROSS ID
TX4260714OtherAETNA ID
TXT12495Medicare UPIN