Provider Demographics
NPI:1710251442
Name:BUXBAUM, ADAM ELIJAH (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ELIJAH
Last Name:BUXBAUM
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 1:5373 W CANAL DR # 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1332
Mailing Address - Country:US
Mailing Address - Phone:509-222-1112
Mailing Address - Fax:509-222-1113
Practice Address - Street 1:5373 W CANAL DR # 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1332
Practice Address - Country:US
Practice Address - Phone:509-222-1112
Practice Address - Fax:509-222-1113
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60268192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMP000004556778Medicaid
WAQMP000004556778Medicaid