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General NPI Number Information
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NPI Number | 1912187758
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Entity Type | Organization
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Legal Business Name | BUBANIC CHIROPRACTIC INC.
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 4082 FULTON DRIVE NW
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City | CANTON
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State | OH
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Zip | 44718
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Country | US
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Telephone | 330-491-8100
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Fax | 844-572-2173
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Provider Business Mailing Address
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Address Line | 4082 FULTON DRIVE NW
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City | CANTON
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State | OH
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Zip | 44718
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Country | US
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Telephone | 330-491-8100
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Fax | 844-572-2173
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. BERNARD P. BUBANIC
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Credential | DC DACBSP
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Telephone | 330-491-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1307
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License Number State | OH
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