Healthcare Provider Details

I. General information

NPI: 1205059961
Provider Name (Legal Business Name): GINA A BUTLER L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY # 300
COLUMBIA MO
65201-7167
US

IV. Provider business mailing address

3217 JENNE HILL DR.
COLUMBIA MO
65202-4059
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-9355
  • Fax:
Mailing address:
  • Phone: 360-521-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2009009729
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: