Provider Demographics
NPI:1205059961
Name:BUTLER, GINA A (L AC)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 JENNE HILL DR.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4059
Mailing Address - Country:US
Mailing Address - Phone:360-521-3337
Mailing Address - Fax:
Practice Address - Street 1:1705 E BROADWAY # 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7167
Practice Address - Country:US
Practice Address - Phone:573-449-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist