Healthcare Provider Details

I. General information

NPI: 1215900097
Provider Name (Legal Business Name): JERRY KEITH BUXMANN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 N WAYNE RD
WESTLAND MI
48185-3170
US

IV. Provider business mailing address

5990 N WAYNE RD
WESTLAND MI
48185-3170
US

V. Phone/Fax

Practice location:
  • Phone: 734-722-3331
  • Fax:
Mailing address:
  • Phone: 734-722-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: