Healthcare Provider Details

I. General information

NPI: 1063953503
Provider Name (Legal Business Name): DONALD BUTTERFIELD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE STE 121B
ALBUQUERQUE NM
87112-1869
US

IV. Provider business mailing address

2901 JUAN TABO BLVD SUITE 121B
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 801-695-5720
  • Fax:
Mailing address:
  • Phone: 505-697-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: