Provider Demographics
NPI:1538549290
Name:BUCHANAN, RACHAEL DILLON (LMT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DILLON
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMT
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 2647
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:CA
Mailing Address - Zip Code:95223-2647
Mailing Address - Country:US
Mailing Address - Phone:209-795-2697
Mailing Address - Fax:
Practice Address - Street 1:1265 OAK CIRCLE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223
Practice Address - Country:US
Practice Address - Phone:209-795-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA29167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist