Provider Demographics
NPI:1952647703
Name:MARK J. BUTTERFIELD, D.C.
Entity Type:Organization
Organization Name:MARK J. BUTTERFIELD, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OR CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-294-0104
Mailing Address - Street 1:3007 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4725
Mailing Address - Country:US
Mailing Address - Phone:503-294-0104
Mailing Address - Fax:503-294-0785
Practice Address - Street 1:3007 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4725
Practice Address - Country:US
Practice Address - Phone:503-294-0104
Practice Address - Fax:503-294-0785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK J. BUTTERFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty