Provider Demographics
NPI:1558489658
Name:BUTLER CHIROPRACTIC HEALTH CLINIC, PC
Entity Type:Organization
Organization Name:BUTLER CHIROPRACTIC HEALTH CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-5114
Mailing Address - Street 1:1802 DEARBORN AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7706
Mailing Address - Country:US
Mailing Address - Phone:406-728-5114
Mailing Address - Fax:
Practice Address - Street 1:1802 DEARBORN AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7706
Practice Address - Country:US
Practice Address - Phone:406-728-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT595111N00000X
MT561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0162448Medicaid
MTMSF0952442OtherMONTANA STATE FUND
MT0163436Medicaid