Provider Demographics
NPI:1063599462
Name:BUTLER, MICHAEL S (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 WESTLINE INDUSTRIAL DR
Mailing Address - Street 2:ROAD
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3200
Mailing Address - Country:US
Mailing Address - Phone:636-394-1200
Mailing Address - Fax:314-569-1623
Practice Address - Street 1:11911 WESTLINE INDUSTRIAL DR
Practice Address - Street 2:ROAD
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3200
Practice Address - Country:US
Practice Address - Phone:636-394-1200
Practice Address - Fax:314-569-1623
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004747111N00000X
MO9177913995247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43447Medicare UPIN
000013508Medicare ID - Type Unspecified