Provider Demographics
NPI:1073629101
Name:BUFFALINO, LOUIS J (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:BUFFALINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1133 MILITARY CUTOFF RD
Mailing Address - Street 2:STE 110
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4403
Mailing Address - Country:US
Mailing Address - Phone:406-222-4444
Mailing Address - Fax:406-222-9796
Practice Address - Street 1:1133 MILITARY CUTOFF RD
Practice Address - Street 2:STE 110
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4403
Practice Address - Country:US
Practice Address - Phone:406-222-4444
Practice Address - Fax:406-222-9796
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT909CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0164125Medicaid
MT0164125Medicaid