Provider Demographics
NPI:1659366458
Name:BUTYKOS, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BUTYKOS
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 1:19200 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-3203
Mailing Address - Country:US
Mailing Address - Phone:313-278-4420
Mailing Address - Fax:313-563-1300
Practice Address - Street 1:19200 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-3203
Practice Address - Country:US
Practice Address - Phone:313-278-4420
Practice Address - Fax:313-563-1300
Is Sole Proprietor?:No
Enumeration Date:2005-09-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OH251240OtherBLUECROSS BLUESCHIELD
MI561401OtherSELECTCARE
MIDR820008OtherM-CARE
MIP83516OtherBLUE CARE NETWORK
MIDR820008OtherM-CARE
MI561401OtherSELECTCARE