Provider Demographics
NPI:1427303429
Name:BUTZKE SPINE AND SPORTS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BUTZKE SPINE AND SPORTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:BUTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-499-6669
Mailing Address - Street 1:7220 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1537
Mailing Address - Country:US
Mailing Address - Phone:402-499-6669
Mailing Address - Fax:
Practice Address - Street 1:7220 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1537
Practice Address - Country:US
Practice Address - Phone:402-499-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty