Provider Demographics
NPI:1184828840
Name:BUFFENMYER, JEFFRY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:J
Last Name:BUFFENMYER
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 1:350 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1302
Mailing Address - Country:US
Mailing Address - Phone:717-354-8823
Mailing Address - Fax:717-355-2557
Practice Address - Street 1:350 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1302
Practice Address - Country:US
Practice Address - Phone:717-354-8823
Practice Address - Fax:717-355-2557
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002801-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131019Medicare UPIN
PA131019Medicare ID - Type Unspecified