Healthcare Provider Details

I. General information

NPI: 1073645750
Provider Name (Legal Business Name): BUZZELL CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N BROADWAY
MASSAPEQUA NY
11758-2381
US

IV. Provider business mailing address

903 N BROADWAY
MASSAPEQUA NY
11758-2381
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-5956
  • Fax: 516-799-9643
Mailing address:
  • Phone: 516-766-5956
  • Fax: 516-799-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX007296
License Number StateNY

VIII. Authorized Official

Name: DR. GREGORY EMANUEL BUZZELL
Title or Position: OWNER
Credential: DC
Phone: 516-799-5956