Provider Demographics
NPI:1851504849
Name:BUZZELLA, ERNEST D JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:D
Last Name:BUZZELLA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EJ
Other - Middle Name:
Other - Last Name:BUZZELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:6129 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3234
Mailing Address - Country:US
Mailing Address - Phone:813-403-9992
Mailing Address - Fax:
Practice Address - Street 1:6129 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3234
Practice Address - Country:US
Practice Address - Phone:813-403-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVO4442Medicare UPIN