Provider Demographics
NPI:1407865280
Name:BUCHBERGER, DALE J I (MPT DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:J
Last Name:BUCHBERGER
Suffix:I
Gender:M
Credentials:MPT DC
Other - Prefix:
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Mailing Address - Street 1:91 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3121
Mailing Address - Country:US
Mailing Address - Phone:315-515-3117
Mailing Address - Fax:315-515-3121
Practice Address - Street 1:40 WEST LAKE AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-515-3117
Practice Address - Fax:315-515-3121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283902251X0800X
NYX008418-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No111NX0800XChiropractic ProvidersChiropractorOrthopedic