Provider Demographics
NPI:1114933173
Name:BUTTON, STEPHEN VICTOR (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VICTOR
Last Name:BUTTON
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 1:1243 W LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2227
Mailing Address - Country:US
Mailing Address - Phone:336-786-6095
Mailing Address - Fax:336-786-1003
Practice Address - Street 1:1243 W LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2227
Practice Address - Country:US
Practice Address - Phone:336-786-6095
Practice Address - Fax:336-786-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1913111NI0900X
VA0104001100111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0828KOtherBLUECROSS/BLUESHIELD/NC
NC11736OtherPARTNERS
VA318792OtherBSBSVA
NC890828KMedicaid
040905Medicare UPIN
NC0828KOtherBLUECROSS/BLUESHIELD/NC