Provider Demographics
NPI:1508950940
Name:BUTTERFIELD CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BUTTERFIELD CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/D.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-865-3052
Mailing Address - Street 1:420 N MAPLE STREET
Mailing Address - Street 2:P.O. BOX 267
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452
Mailing Address - Country:US
Mailing Address - Phone:812-865-3052
Mailing Address - Fax:812-865-3206
Practice Address - Street 1:420 N MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452
Practice Address - Country:US
Practice Address - Phone:812-865-3052
Practice Address - Fax:812-865-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001389A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200125630AMedicaid
INU30511Medicare UPIN
IN200125630AMedicaid