Provider Demographics
NPI:1154363281
Name:BUCHANAN, GARRY E (DC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:E
Last Name:BUCHANAN
Suffix:
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0067
Mailing Address - Country:US
Mailing Address - Phone:812-738-1935
Mailing Address - Fax:812-738-1935
Practice Address - Street 1:1995 ALLISON LN NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2151
Practice Address - Country:US
Practice Address - Phone:812-738-1935
Practice Address - Fax:812-738-1935
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000701A111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000067673OtherBLUE CROSS/SHIELD NUMBER
INU26420Medicare UPIN
IN730480Medicare ID - Type UnspecifiedMEDICARE