Provider Demographics
NPI:1932523040
Name:BUCHANAN CHIROPRACTIC & REHABILITATION, LLC
Entity type:Organization
Organization Name:BUCHANAN CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-362-3164
Mailing Address - Street 1:8140 COLLEGE PARKWAY
Mailing Address - Street 2:UNIT 108
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-362-3164
Mailing Address - Fax:239-791-8632
Practice Address - Street 1:8140 COLLEGE PKWY
Practice Address - Street 2:UNIT 108
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5188
Practice Address - Country:US
Practice Address - Phone:239-362-3164
Practice Address - Fax:239-791-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9348261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty