Provider Demographics
NPI:1629179775
Name:BUCHHOLZ, JAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:SCOTT
Last Name:BUCHHOLZ
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 1:3770 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1152
Mailing Address - Country:US
Mailing Address - Phone:954-731-4900
Mailing Address - Fax:954-731-4901
Practice Address - Street 1:3770 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1152
Practice Address - Country:US
Practice Address - Phone:954-731-4900
Practice Address - Fax:954-731-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22720Medicare PIN