Provider Demographics
NPI:1114638434
Name:BUCHANAN, GREGORY D (LMT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:D
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 N LAKE PARK AVE APT E4S
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-3026
Mailing Address - Country:US
Mailing Address - Phone:219-805-4155
Mailing Address - Fax:219-945-0412
Practice Address - Street 1:1649 E 80TH AVE STE 407
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5737
Practice Address - Country:US
Practice Address - Phone:219-614-2777
Practice Address - Fax:219-945-0412
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20901901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist