MEDICARE: RONDA BUTLER 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01623140	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1770552036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA BUTLER D.C.

Provider Business Mailing Address
First Line	:	2536 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2536 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2348
Country	:	US
Telephone Number	:	773-529-6530
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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