Provider Demographics
NPI:1972602548
Name:BUCLAW, ROBERT EDWARD III (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:BUCLAW
Suffix:III
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:PO BOX 23955
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0955
Mailing Address - Country:US
Mailing Address - Phone:253-632-5320
Mailing Address - Fax:253-214-7444
Practice Address - Street 1:1707 S 341ST PL STE A
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6867
Practice Address - Country:US
Practice Address - Phone:253-632-5320
Practice Address - Fax:253-214-7444
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1464111N00000X
CO5690111N00000X
WACH00034618111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0346489OtherWA STATE LABOR AND INDUSTRY PIN
WAU75178Medicare UPIN
WAG8934292Medicare PIN