Provider Demographics
NPI:1295728723
Name:BUETTNER, JACALYN (DC)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:
Last Name:BUETTNER
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 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 825
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-421-1924
Mailing Address - Fax:421-421-2116
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 825
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-421-1924
Practice Address - Fax:421-421-2116
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2015-11-05
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CADC17240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0172400OtherBLUE SHIELD
CADC017240OtherGROUP HEALTH
CADC0172400OtherBLUE CROSS
CADC0172400Medicare ID - Type Unspecified