Provider Demographics
NPI:1417989658
Name:BUCHANAN, TIGE R (DC)
Entity Type:Individual
Prefix:
First Name:TIGE
Middle Name:R
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 1:9836 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7273
Mailing Address - Country:US
Mailing Address - Phone:352-787-8531
Mailing Address - Fax:352-787-3041
Practice Address - Street 1:32815 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3902
Practice Address - Country:US
Practice Address - Phone:352-787-8531
Practice Address - Fax:352-787-3041
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU91527Medicare UPIN
FLE7896Medicare ID - Type Unspecified