Provider Demographics
NPI:1821474057
Name:BUTZEN, MELISSA A (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BUTZEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:BURGHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:250 N GREEN BAY RD
Mailing Address - Street 2:STE B
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2285
Mailing Address - Country:US
Mailing Address - Phone:920-725-3333
Mailing Address - Fax:
Practice Address - Street 1:250 N GREEN BAY RD
Practice Address - Street 2:STE B
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2285
Practice Address - Country:US
Practice Address - Phone:920-725-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5090-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100049099Medicaid
WI100049099Medicaid