Provider Demographics
NPI:1760550263
Name:BUCHANAN, NICOLE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENEE
Last Name:BUCHANAN
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 1:1830 W COLTER ST
Mailing Address - Street 2:102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-9000
Mailing Address - Country:US
Mailing Address - Phone:602-995-1295
Mailing Address - Fax:602-995-1296
Practice Address - Street 1:1830 W COLTER ST
Practice Address - Street 2:102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-9000
Practice Address - Country:US
Practice Address - Phone:602-995-1295
Practice Address - Fax:602-995-1296
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor