Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC006741-L | PA |
NPI | 1336195825 |
---|---|
Provider Name | Dr. Nicholas Anthony Bufanio |
First Address | Bethlehem, PA 18020-9459 |
Second Address | Bethlehem, PA 18020-9459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 24/04/2018 |