Provider Demographics
NPI:1942632179
Name:BUTLER, MARJORIE VINING (DC)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:VINING
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 OLD PHOENIX RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5610
Mailing Address - Country:US
Mailing Address - Phone:706-485-1010
Mailing Address - Fax:
Practice Address - Street 1:639 OLD PHOENIX RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5610
Practice Address - Country:US
Practice Address - Phone:706-485-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor