Healthcare Provider Details

I. General information

NPI: 1205870144
Provider Name (Legal Business Name): ROBERT DARRELL BUCHANAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 PASEO DE VALENCIA ST
FORT MYERS FL
33908-9658
US

IV. Provider business mailing address

8849 PASEO DE VALENCIA ST
FORT MYERS FL
33908-9658
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-6777
  • Fax:
Mailing address:
  • Phone: 239-482-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC005847L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: