=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184137846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT W BUECHEL DC CHIROPRACTIC CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4747 MISSION BLVD STE 6
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-866-6688
-----------------------------------------------------
Fax | 858-362-7468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4747 MISSION BLVD STE 6
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-866-6688
-----------------------------------------------------
Fax | 858-362-7468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT WESLEY BUECHEL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 858-866-6688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | DC26017
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------