Provider Demographics
NPI:1780791145
Name:BUTZIN, JASON ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
Last Name:BUTZIN
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 1:2050 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4818
Mailing Address - Country:US
Mailing Address - Phone:586-268-8882
Mailing Address - Fax:586-268-5305
Practice Address - Street 1:27322 23 MILE RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2032
Practice Address - Country:US
Practice Address - Phone:586-598-9120
Practice Address - Fax:586-598-9155
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB008115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4754026Medicaid
MIU83146Medicare UPIN
MIN98450001Medicare ID - Type Unspecified