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General NPI Number Information
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NPI Number | 1952160319
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Entity Type | Individual
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Provider Name | COREY BRANDON BUCHALTER DC
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Gender | Male
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 18 VIA DELUNA DRIVE 303A
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City | PENSACOLA BEACH
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State | FL
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Zip | 32561
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Country | US
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Telephone | 850-454-8148
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Fax |
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Provider Business Mailing Address
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Address Line | 362 GULF BREEZE PKWY # 138
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City | GULF BREEZE
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State | FL
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Zip | 32561-4492
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Country | US
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Telephone | 850-454-8148
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH14050
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License Number State | FL
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