Provider Demographics
NPI:1306889266
Name:BUFFINGTON, AMANDA JOY (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 TALON DR
Mailing Address - Street 2:STE B
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:618-622-1200
Mailing Address - Fax:314-270-5283
Practice Address - Street 1:922 TALON DR
Practice Address - Street 2:SUITE B
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1848
Practice Address - Country:US
Practice Address - Phone:618-622-1200
Practice Address - Fax:314-270-5283
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27489Medicare ID - Type UnspecifiedEB MEDICARE NUMBER