Provider Demographics
NPI:1790788131
Name:BUCHANAN, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:BUCHANAN
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:PO BOX 2160
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8909
Mailing Address - Country:US
Mailing Address - Phone:770-474-6680
Mailing Address - Fax:770-474-3633
Practice Address - Street 1:5124 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3232
Practice Address - Country:US
Practice Address - Phone:770-474-6680
Practice Address - Fax:770-474-3633
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-09-14
Deactivation Date:2006-04-04
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
GACHIR002282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T97517Medicare UPIN