Provider Demographics
NPI:1225014426
Name:BUXTON, BRADLY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:J
Last Name:BUXTON
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 1:2912 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2706
Mailing Address - Country:US
Mailing Address - Phone:336-282-2525
Mailing Address - Fax:336-282-7554
Practice Address - Street 1:2912 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2706
Practice Address - Country:US
Practice Address - Phone:336-282-2525
Practice Address - Fax:336-282-7554
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08288OtherNC BCBS PROVIDER NUMBER
NC89-08288Medicaid
NC330073OtherUNITED HEALTHCARE
NC1369OtherPARTNERS
NC330073OtherUNITED HEALTHCARE