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General NPI Number Information
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NPI Number | 1114638434
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Entity Type | Individual
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Provider Name | GREGORY D BUCHANAN LMT
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Gender | Male
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1649 E 80TH AVE STE 407
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5737
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Country | US
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Telephone | 219-614-2777
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Fax | 219-945-0412
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Provider Business Mailing Address
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Address Line | 400 N LAKE PARK AVE APT E4S
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City | HOBART
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State | IN
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Zip | 46342-3026
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Country | US
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Telephone | 219-805-4155
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Fax | 219-945-0412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT20901901
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License Number State | IN
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