Provider Demographics
NPI:1336212539
Name:BUTLER, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:BUTLER
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 1:2278 MOODY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3247
Mailing Address - Country:US
Mailing Address - Phone:478-918-0102
Mailing Address - Fax:
Practice Address - Street 1:2278 MOODY RD
Practice Address - Street 2:SUITE C
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3247
Practice Address - Country:US
Practice Address - Phone:478-918-0102
Practice Address - Fax:478-975-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFCNMedicare ID - Type Unspecified