Provider Demographics
NPI:1366909400
Name:BUTZBACH, HERB WILLIAM IV (DC)
Entity type:Individual
Prefix:DR
First Name:HERB
Middle Name:WILLIAM
Last Name:BUTZBACH
Suffix:IV
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 1:13078 S SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9484
Mailing Address - Country:US
Mailing Address - Phone:913-461-9070
Mailing Address - Fax:
Practice Address - Street 1:463 S THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-2133
Practice Address - Country:US
Practice Address - Phone:913-461-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor