Provider Demographics
NPI:1972500643
Name:BUELT, BRIAN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:BUELT
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 1:672 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3549
Mailing Address - Country:US
Mailing Address - Phone:309-343-5175
Mailing Address - Fax:309-343-2519
Practice Address - Street 1:672 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3549
Practice Address - Country:US
Practice Address - Phone:309-343-5175
Practice Address - Fax:309-343-2519
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004882016OtherBC/CS
ILT87382Medicare UPIN
IL905360Medicare ID - Type Unspecified