Provider Demographics
NPI:1124384094
Name:BUXBAUM FAMILY CHIROPRACTIC & MASSAGE, L.L.C.
Entity Type:Organization
Organization Name:BUXBAUM FAMILY CHIROPRACTIC & MASSAGE, L.L.C.
Other - Org Name:BUXBAUM FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ELIJAH
Authorized Official - Last Name:BUXBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-302-0361
Mailing Address - Street 1:7131 W DESCHUTES AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7801
Mailing Address - Country:US
Mailing Address - Phone:509-302-0361
Mailing Address - Fax:509-222-1113
Practice Address - Street 1:7131 W DESCHUTES AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7801
Practice Address - Country:US
Practice Address - Phone:509-302-0361
Practice Address - Fax:509-222-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60268192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMP000004556778Medicaid
WA68911064OtherPTAN