Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 08001533 | IN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 08001533 | IN |
NPI | 1134124290 |
---|---|
Provider Name | Dr. Daniel Paul Bukofchan |
First Address | Brookville, IN 47012-0387 |
Second Address | Brookville, IN 47012-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38384 | (02) |