MEDICARE: ROBERT J BANUCHI DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	CH6556	FL

General Provider Information

NPI Number	:	1568777225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J BANUCHI DC PA

Provider Business Mailing Address
First Line	:	3850 LAKE WORTH RD STE 2
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4000
Country	:	US
Telephone Number	:	561-966-1775
Fax Number	:	561-966-3934

Provider Business Practice Location Address
First Line	:	3850 LAKE WORTH RD STE 2
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4000
Country	:	US
Telephone Number	:	561-966-1775
Fax Number	:	561-966-3934

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROBERT J BANUCHI
Credential	:	D.C, P.A.
Telephone Number	:	561-966-1775

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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