Provider Demographics
NPI:1215976774
Name:BUTLER, TRACI RENEA (DC)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:RENEA
Last Name:BUTLER
Suffix:
Gender:F
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:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-0285
Mailing Address - Country:US
Mailing Address - Phone:563-659-2225
Mailing Address - Fax:
Practice Address - Street 1:604 10TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1337
Practice Address - Country:US
Practice Address - Phone:563-659-2225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA59955OtherWELLMARK BC / BS
IA22538OtherMIDLAND CHOICE
IA59955Medicare ID - Type Unspecified