Provider Demographics
NPI:1932508629
Name:COMMUNITY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUFANIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-746-4332
Mailing Address - Street 1:216 NAZARETH PIKE
Mailing Address - Street 2:BLDG. B STE.3.
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9414
Mailing Address - Country:US
Mailing Address - Phone:610-746-4332
Mailing Address - Fax:610-746-4328
Practice Address - Street 1:216 NAZARETH PIKE
Practice Address - Street 2:BLDG. B STE.3.
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9414
Practice Address - Country:US
Practice Address - Phone:610-746-4332
Practice Address - Fax:610-746-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006741L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001422OtherPTAN