MEDICARE: DR. RICHARD BUTYKOS D.C.

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	BLUECROSS BLUESCHIELD
2	561401	OTHER	MI	SELECTCARE
3	DR820008	OTHER	MI	M-CARE
4	P83516	OTHER	MI	BLUE CARE NETWORK

General Provider Information

NPI Number	:	1659366458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD BUTYKOS D.C.

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2005
Last Update Date	:	07/08/2007

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