Provider Demographics
NPI:1639172380
Name:BUCHAKJIAN, TARA LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNNE
Last Name:BUCHAKJIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOME RD
Mailing Address - Street 2:P.O.BOX 508
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2026
Mailing Address - Country:US
Mailing Address - Phone:215-444-0441
Mailing Address - Fax:215-394-5428
Practice Address - Street 1:2 HOME RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2026
Practice Address - Country:US
Practice Address - Phone:215-464-6922
Practice Address - Fax:215-394-5428
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009377111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06161Medicare UPIN