Healthcare Provider Details

I. General information

NPI: 1407865280
Provider Name (Legal Business Name): DALE J BUCHBERGER I MPT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WEST LAKE AVE
AUBURN NY
13021
US

IV. Provider business mailing address

91 COLUMBUS ST
AUBURN NY
13021-3121
US

V. Phone/Fax

Practice location:
  • Phone: 315-515-3117
  • Fax: 315-515-3121
Mailing address:
  • Phone: 315-515-3117
  • Fax: 315-515-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number028390
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX008418-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: