MEDICARE: DR. BRIAN CHRISTOPHER BUELT D.C.

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	111N00000X	Chiropractor	038006438	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004882016	OTHER	IL	BC/CS

General Provider Information

NPI Number	:	1972500643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CHRISTOPHER BUELT D.C.

Provider Business Mailing Address
First Line	:	672 W MAIN ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-3549
Country	:	US
Telephone Number	:	309-343-5175
Fax Number	:	309-343-2519

Provider Business Practice Location Address
First Line	:	672 W MAIN ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-3549
Country	:	US
Telephone Number	:	309-343-5175
Fax Number	:	309-343-2519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2010

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