Healthcare Provider Details

I. General information

NPI: 1245688738
Provider Name (Legal Business Name): SARA BUTKOVICH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 KING ST
KEYSVILLE VA
23947-0024
US

IV. Provider business mailing address

176 KING ST
KEYSVILLE VA
23947-0024
US

V. Phone/Fax

Practice location:
  • Phone: 434-736-9895
  • Fax:
Mailing address:
  • Phone: 434-736-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4648
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: