MEDICARE: BUTZIN CHIROPRACTIC CLINIC LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174285811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTZIN CHIROPRACTIC CLINIC LLC

Provider Business Mailing Address
First Line	:	57540 STONEBRIAR DR
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48094-3168
Country	:	US
Telephone Number	:	586-268-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 CHESLEY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4818
Country	:	US
Telephone Number	:	586-268-8882
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	LORI A MATOSHKO
Credential	:
Telephone Number	:	586-268-8882

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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