Individual provider Active NPI

Timothy M Butcko, D.C.

  • Chiropractor
  • East Lansing, MI
National Provider Identifier
1285872192
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010138 Issued in MI
Practice address
2045 Asher CT
East Lansing, MI 48823
Phone
(517) 351-9240
NPI assigned
Jan 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.011310 IL
Chiropractor 111N00000X 2301010138 MI Primary

Addresses

Primary practice location

2045 Asher CT
East Lansing, MI 48823

Mailing address

2045 Asher CT
East Lansing, MI 48823
Phone (517) 351-9240

Other identifiers 1

IdentifierTypeStateIssuer
1629625OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140228001608 MI Practitioner - Chiropractic 8527118165 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301010138MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Quest Health Systems PLLC Chiropractor CurrentSince Jun 1, 2022 Accepting new patients
Quest Health Systems VI PLLC Chiropractor CurrentSince Nov 1, 2021 Accepting new patients
Healthquest of Jackson PLLC Chiropractor CurrentSince Sep 21, 2022 Accepting new patients

Locations

1011 S Van Dyke Rd
Ste A
Bad Axe, MI 48413
Phone (989) 269-5015

500 Perry Rd
Ste 101
Grand Blanc, MI 48439
Phone (810) 771-7624

1023 E Ganson St
Jackson, MI 49201
Phone (517) 784-3388

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1285872192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 ASHER CT",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "48823",
            "telephone_number": "517-351-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 ASHER CT",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "48823",
            "telephone_number": "517-351-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTCKO",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-30",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011310",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1629625",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.