Provider Demographics
NPI:1235282898
Name:BUCHANAN, GLENN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:BUCHANAN
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 1:6206 S 238TH PL
Mailing Address - Street 2:#FF303
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3616
Mailing Address - Country:US
Mailing Address - Phone:253-520-1205
Mailing Address - Fax:253-639-8542
Practice Address - Street 1:17224 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4953
Practice Address - Country:US
Practice Address - Phone:253-639-8540
Practice Address - Fax:253-639-8542
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32167Medicare ID - Type Unspecified