Provider Demographics
NPI:1215900097
Name:BUXMANN, JERRY KEITH (DC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:KEITH
Last Name:BUXMANN
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 1:5990 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3170
Mailing Address - Country:US
Mailing Address - Phone:734-722-3331
Mailing Address - Fax:
Practice Address - Street 1:5990 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3170
Practice Address - Country:US
Practice Address - Phone:734-722-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH251613951Medicare ID - Type Unspecified
T33710Medicare UPIN