Provider Demographics
NPI:1053961870
Name:BUTLER, MATTHEW BROOKS (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BROOKS
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 1:2911 CROSSING COURT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:217-359-0550
Mailing Address - Fax:217-359-0808
Practice Address - Street 1:2911 CROSSING COURT
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-359-0550
Practice Address - Fax:217-359-0808
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor