MEDICARE: RICHARD BUTYKOS DC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2815	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95OH251240	OTHER	MI	BCBS
2	DR820008	OTHER	MI	MCARE

General Provider Information

NPI Number	:	1083776124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD BUTYKOS DC, INC.

Provider Business Mailing Address
First Line	:	19200 VAN BORN RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48125-3203
Country	:	US
Telephone Number	:	313-278-4420
Fax Number	:	313-563-1300

Provider Business Practice Location Address
First Line	:	19200 VAN BORN RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48125-3203
Country	:	US
Telephone Number	:	313-278-4420
Fax Number	:	313-563-1300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD BUTYKOS
Credential	:	D.C.
Telephone Number	:	313-278-4420

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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