Healthcare Provider Details

I. General information

NPI: 1255437687
Provider Name (Legal Business Name): ROBERT BANUCHI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 N FEDERAL HWY SUITE 2
BOCA RATON FL
33487-4012
US

IV. Provider business mailing address

5601 N FEDERAL HWY SUITE 2
BOCA RATON FL
33487-4012
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-7660
  • Fax: 561-997-7661
Mailing address:
  • Phone: 561-997-7660
  • Fax: 561-997-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: