Provider Demographics
NPI:1619004843
Name:BUSCHKOETTER, DUANE A (DC)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:A
Last Name:BUSCHKOETTER
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 1:4195 MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9625
Mailing Address - Country:US
Mailing Address - Phone:812-634-7000
Mailing Address - Fax:812-634-7001
Practice Address - Street 1:4195 MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9625
Practice Address - Country:US
Practice Address - Phone:812-634-7000
Practice Address - Fax:812-634-7001
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212470Medicare ID - Type Unspecified
INU30716Medicare UPIN