Provider Demographics
NPI:1912187758
Name:BUBANIC CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BUBANIC CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUBANIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACBSP
Authorized Official - Phone:330-491-8100
Mailing Address - Street 1:4082 FULTON DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-491-8100
Mailing Address - Fax:844-572-2173
Practice Address - Street 1:4082 FULTON DRIVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-491-8100
Practice Address - Fax:844-572-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T48598Medicare UPIN
OH9320611Medicare PIN