Provider Demographics
NPI:1073645750
Name:BUZZELL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BUZZELL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:BUZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-799-5956
Mailing Address - Street 1:903 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2381
Mailing Address - Country:US
Mailing Address - Phone:516-766-5956
Mailing Address - Fax:516-799-9643
Practice Address - Street 1:903 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2381
Practice Address - Country:US
Practice Address - Phone:516-766-5956
Practice Address - Fax:516-799-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007296111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X60131Medicare ID - Type Unspecified