Healthcare Provider Details

I. General information

NPI: 1932523040
Provider Name (Legal Business Name): BUCHANAN CHIROPRACTIC & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY UNIT 108
FORT MYERS FL
33919-5188
US

IV. Provider business mailing address

8140 COLLEGE PARKWAY UNIT 108
FORT MYERS FL
33919
US

V. Phone/Fax

Practice location:
  • Phone: 239-362-3164
  • Fax: 239-791-8632
Mailing address:
  • Phone: 239-362-3164
  • Fax: 239-791-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberCH9348
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT DARRELL BUCHANAN
Title or Position: DOCTOR/OWNER
Credential: DC
Phone: 239-362-3164