MEDICARE: DR. CHAD DAVID BUOHL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC007552L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10923906	OTHER	PA	TRIAD
2	50030447	OTHER	PA	BLUE CROSS
3	3000240	OTHER	PA	HMO KEYSTONE
4	50030444	OTHER	PA	KEYSTONE BC HMO
5	903165	OTHER	PA	HIGHMARK BLUE SHIELD
6	3478163	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1386613925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD DAVID BUOHL D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1010
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-1010
Country	:	US
Telephone Number	:	717-259-8813
Fax Number	:	717-259-0988

Provider Business Practice Location Address
First Line	:	337 W KING ST
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-9730
Country	:	US
Telephone Number	:	717-259-8813
Fax Number	:	717-259-0988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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