Provider Demographics
NPI:1821003526
Name:BUCKWALTER, ROBIN GAYLE (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:GAYLE
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:DC, QME
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 3328
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-0332
Mailing Address - Country:US
Mailing Address - Phone:510-656-1192
Mailing Address - Fax:510-770-0884
Practice Address - Street 1:43353 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5828
Practice Address - Country:US
Practice Address - Phone:510-656-1192
Practice Address - Fax:510-770-0284
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18746OtherCHIROPRACTIC LICENSE
CA18746OtherCHIROPRACTIC LICENSE