MEDICARE: DR. JESSE IAN BUTTLER N.D.

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	175F00000X	Naturopath	1592	OR

General Provider Information

NPI Number	:	1760667083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE IAN BUTTLER N.D.

Provider Business Mailing Address
First Line	:	2305 SE WASHINGTON ST STE 104
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7647
Country	:	US
Telephone Number	:	503-786-2181
Fax Number	:	503-200-2259

Provider Business Practice Location Address
First Line	:	2305 SE WASHINGTON ST STE 104
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7647
Country	:	US
Telephone Number	:	503-786-2181
Fax Number	:	503-200-2259

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

Provider Enumeration Date	:	01/05/2008
Last Update Date	:	01/05/2008

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