Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC005847L | PA |
NPI | 1205870144 |
---|---|
Provider Name | Dr. Robert Darrell Buchanan |
First Address | Fort Myers, FL 33908-9658 |
Second Address | Fort Myers, FL 33908-9658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 06/02/2014 |