Provider Demographics
NPI:1376539569
Name:BUCHANAN, MARDI ANN (DC)
Entity Type:Individual
Prefix:MS
First Name:MARDI
Middle Name:ANN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 E 1ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1467
Mailing Address - Country:US
Mailing Address - Phone:407-324-9691
Mailing Address - Fax:407-688-0448
Practice Address - Street 1:819 E 1ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1467
Practice Address - Country:US
Practice Address - Phone:407-324-9691
Practice Address - Fax:407-688-0448
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5133Medicare ID - Type Unspecified
FL498377Medicare UPIN