Provider Demographics
NPI:1891054722
Name:BUCKHANNON DC, ROBERT LYLE (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYLE
Last Name:BUCKHANNON DC
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 1:200 WAHWAHTAYSEE WAY
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4061
Mailing Address - Country:US
Mailing Address - Phone:126-983-0984
Mailing Address - Fax:
Practice Address - Street 1:2846 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4106
Practice Address - Country:US
Practice Address - Phone:126-983-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor