MEDICARE: DR RANDAL L BUTCH DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6103	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801845789	OTHER	FL	NPI FOR SS NUMBER

General Provider Information

NPI Number	:	1073667325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR RANDAL L BUTCH DC PA

Provider Business Mailing Address
First Line	:	8229 113TH ST
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-4128
Country	:	US
Telephone Number	:	727-398-3999
Fax Number	:	727-397-3777

Provider Business Practice Location Address
First Line	:	8229 113TH ST
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-4128
Country	:	US
Telephone Number	:	727-398-3999
Fax Number	:	727-397-3777

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	RANDAL LEE BUTCH
Credential	:	DC
Telephone Number	:	727-398-3999

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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