MEDICARE: DR. PHILLIP SANTE BUTCH DC

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	4267	OH
2	111N00000X	Chiropractor	CHIR009398	GA

General Provider Information

NPI Number	:	1730443789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP SANTE BUTCH DC

Provider Business Mailing Address
First Line	:	514 W BANKHEAD HWY STE 300
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1737
Country	:	US
Telephone Number	:	770-459-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 W BANKHEAD HWY STE 300
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1737
Country	:	US
Telephone Number	:	330-296-5619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	05/05/2015

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