MEDICARE: CHAD D. BUOHL, PC

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	111N00000X	Chiropractor	DC007522L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50030447	OTHER	PA	GROUP KEYSTONE HMO
2	903165	OTHER	PA	HIGHMARK BLUE SHIELD
3	10923906	OTHER	PA	CAQH TRIAD HEALTH AMERICA
4	3478163	OTHER	PA	AETNA HMO
5	7373065	OTHER	PA	AETNA PPO
6	50030447	OTHER	PA	BLUE CROSS GROUP

General Provider Information

NPI Number	:	1598881260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD D. BUOHL, PC

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	:	CHIROPRACTOR
Name	:	DR. CHAD DAVID BUOHL
Credential	:	D.C.
Telephone Number	:	717-259-8813

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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