Individual
DR. KELLY T. BUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4470 HWY 95, STE 9, FORT MOHAVE, AZ 86426-9101
(928) 763-9308
(928) 758-7035
Mailing address
PO BOX 11697, FORT MOHAVE, AZ 86427
(928) 763-9308
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2533
MN
111N00000X
Chiropractor
Primary
4462
AZ
111N00000X
Chiropractor
4883
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0233570
BC/BS PREFERRED PROVIDER
AZ
Enumeration date
09/02/2006
Last updated
08/13/2020
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