Healthcare Provider Details

I. General information

NPI: 1063599462
Provider Name (Legal Business Name): MICHAEL S BUTLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 WESTLINE INDUSTRIAL DR ROAD
SAINT LOUIS MO
63146-3200
US

IV. Provider business mailing address

11911 WESTLINE INDUSTRIAL DR ROAD
SAINT LOUIS MO
63146-3200
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-1200
  • Fax: 314-569-1623
Mailing address:
  • Phone: 636-394-1200
  • Fax: 314-569-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004747
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number9177913995
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: