=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306426747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY BUTLER DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2021
-----------------------------------------------------
Last Update Date | 04/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9181 CHILLICOTHE RD
-----------------------------------------------------
City | KIRTLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-9263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-744-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36142 SKYTOP LN
-----------------------------------------------------
City | WILLOUGHBY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-4116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-840-8357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-05048
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------