Provider Demographics
NPI:1972776961
Name:BUTTS, MYRON JAMAL (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:JAMAL
Last Name:BUTTS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1102 TONOPAH AVE.
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744
Mailing Address - Country:US
Mailing Address - Phone:562-587-2065
Mailing Address - Fax:909-622-9051
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:SUITE#148
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:562-587-2065
Practice Address - Fax:909-622-9051
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30680111N00000X
CAAC 12860171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist