1720291842 NPI number — ROBERT W.BUCHANAN DC PA

Table of content: (NPI 1720291842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720291842 NPI number — ROBERT W.BUCHANAN DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT W.BUCHANAN DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
34TH STREET CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720291842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1807 34TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-763-1479
Provider Business Mailing Address Fax Number:
806-763-0826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1807 34TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-763-1479
Provider Business Practice Location Address Fax Number:
806-763-0826
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHANAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
806-763-1479

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7393 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0020KU . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8K1477 . This is a "DR BUCHANANA BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com