Provider Demographics
NPI:1114074986
Name:BUFFIE, PERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:BUFFIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-0207
Mailing Address - Country:US
Mailing Address - Phone:763-477-4266
Mailing Address - Fax:763-477-6228
Practice Address - Street 1:8340 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9578
Practice Address - Country:US
Practice Address - Phone:763-477-4266
Practice Address - Fax:763-477-6228
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046728600Medicaid
MN2935OtherLICENSE
MN350003139Medicare ID - Type Unspecified
MN046728600Medicaid