Healthcare Provider Details

I. General information

NPI: 1558654830
Provider Name (Legal Business Name): CRAIG THOMAS BUTLER JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RICE ST
ELMORE OH
43416-9564
US

IV. Provider business mailing address

PO BOX 327
ELMORE OH
43416-0327
US

V. Phone/Fax

Practice location:
  • Phone: 440-289-4071
  • Fax:
Mailing address:
  • Phone: 419-862-9014
  • Fax: 888-977-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: