MEDICARE: BUTZKE SPINE AND SPORTS CHIROPRACTIC 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	1727	NE

General Provider Information

NPI Number	:	1427303429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTZKE SPINE AND SPORTS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	7220 FAIRFAX AVE
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1537
Country	:	US
Telephone Number	:	402-499-6669
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 FAIRFAX AVE
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1537
Country	:	US
Telephone Number	:	402-499-6669
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. ANDREW CALVIN BUTZKE
Credential	:	D.C.
Telephone Number	:	402-499-6669

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	09/05/2012

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