Provider Demographics
NPI:1720200629
Name:BUTLER, THOMAS R (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BUTLER
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 EAST BISHOP STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823
Mailing Address - Country:US
Mailing Address - Phone:814-355-0032
Mailing Address - Fax:814-353-1099
Practice Address - Street 1:751 EAST BISHOP STREET
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2239
Practice Address - Country:US
Practice Address - Phone:814-355-0032
Practice Address - Fax:814-353-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001415L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor