Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2268 | MN |
NPI | 1003990524 |
---|---|
Provider Name | Dr. David W Butler |
First Address | Alexandria, MN 56308-4517 |
Second Address | Alexandria, MN 56308-4517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T65368 | (02) | MN |