Healthcare Provider Details

I. General information

NPI: 1376513531
Provider Name (Legal Business Name): WILLIAM BUZBUZIAN D.C., L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 GRANT AVE SUITE A
NOVATO CA
94945-3239
US

IV. Provider business mailing address

863 GRANT AVE SUITE A
NOVATO CA
94945-3239
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-0225
  • Fax: 415-897-4185
Mailing address:
  • Phone: 415-892-0225
  • Fax: 415-897-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: