Healthcare Provider Details

I. General information

NPI: 1548980790
Provider Name (Legal Business Name): JACK W BUECHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 42ND ST
SPRINGFIELD OR
97478-5937
US

IV. Provider business mailing address

2050 GOODPASTURE LOOP APT 133
EUGENE OR
97401-1562
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-6987
  • Fax:
Mailing address:
  • Phone: 763-258-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: