Provider Demographics
NPI:1639118334
Name:BUTTERFIELD, KEITH BRUCE (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:BRUCE
Last Name:BUTTERFIELD
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 1:1717 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3712
Mailing Address - Country:US
Mailing Address - Phone:559-472-7314
Mailing Address - Fax:559-891-9800
Practice Address - Street 1:1717 MILL ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3712
Practice Address - Country:US
Practice Address - Phone:559-472-7314
Practice Address - Fax:559-891-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0151510Medicaid
CADC0151510Medicaid
CADC0151510Medicare ID - Type Unspecified