Provider Demographics
NPI:1467583963
Name:DR. JOHN BUELER JR CHIROPRACTIC PROF CORPORATION
Entity Type:Organization
Organization Name:DR. JOHN BUELER JR CHIROPRACTIC PROF CORPORATION
Other - Org Name:LAKE GREGORY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELER JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-338-6477
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-0989
Mailing Address - Country:US
Mailing Address - Phone:909-338-6477
Mailing Address - Fax:909-338-1639
Practice Address - Street 1:580 FOREST SHADE
Practice Address - Street 2:SUITE 4
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-0989
Practice Address - Country:US
Practice Address - Phone:909-338-6477
Practice Address - Fax:909-338-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0170371Medicare ID - Type Unspecified
CA=========Medicare UPIN
CAZZZ07035ZMedicare PIN