Provider Demographics
NPI:1730474479
Name:BUTWIN, BENJAMIN ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:BUTWIN
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 1:890 E 116TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3475
Mailing Address - Country:US
Mailing Address - Phone:317-848-4408
Mailing Address - Fax:317-848-4407
Practice Address - Street 1:890 E 116TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3475
Practice Address - Country:US
Practice Address - Phone:317-848-4408
Practice Address - Fax:317-848-4407
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002596A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor