Provider Demographics
NPI:1881722080
Name:BUTTERNUT CHIROPRACTIC PC
Entity type:Organization
Organization Name:BUTTERNUT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-610-0970
Mailing Address - Street 1:10560 RIVER BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1443
Mailing Address - Country:US
Mailing Address - Phone:616-610-0970
Mailing Address - Fax:
Practice Address - Street 1:10560 RIVER BLUFF TRL
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1443
Practice Address - Country:US
Practice Address - Phone:616-610-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty