Provider Demographics
NPI:1780759233
Name:BUTTERFIELD, BRECK R (DC)
Entity type:Individual
Prefix:DR
First Name:BRECK
Middle Name:R
Last Name:BUTTERFIELD
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 1:18500 156TH AVE NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4459
Mailing Address - Country:US
Mailing Address - Phone:425-424-2112
Mailing Address - Fax:425-424-2127
Practice Address - Street 1:18500 156TH AVE NE
Practice Address - Street 2:SUITE 205
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4459
Practice Address - Country:US
Practice Address - Phone:425-424-2112
Practice Address - Fax:425-424-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0162219OtherL & I
WAGAB32816Medicare PIN