Provider Demographics
NPI:1659389344
Name:BUTTS, ANTHONY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:BUTTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:JOSEPH
Other - Last Name:BUTTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:17215 RED OAK DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2697
Mailing Address - Country:US
Mailing Address - Phone:281-397-6619
Mailing Address - Fax:281-397-7695
Practice Address - Street 1:17215 RED OAK DR
Practice Address - Street 2:SUITE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2697
Practice Address - Country:US
Practice Address - Phone:281-397-6619
Practice Address - Fax:281-397-7695
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11611032OtherCAQH
TX0057NVOtherBCBS
TXV08145Medicare UPIN