Provider Demographics
NPI:1124156963
Name:BUTLER, MARK CLAYTON (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CLAYTON
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 1:5250 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2715
Mailing Address - Country:US
Mailing Address - Phone:412-854-6900
Mailing Address - Fax:412-854-4733
Practice Address - Street 1:5250 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2715
Practice Address - Country:US
Practice Address - Phone:412-854-6900
Practice Address - Fax:412-854-4733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003738-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U07243Medicare UPIN
PA094095Medicare PIN