Provider Demographics
NPI:1104140383
Name:BUZEK, JACE MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:JACE
Middle Name:MATTHEW
Last Name:BUZEK
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 1:135 LONGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:PA
Mailing Address - Zip Code:15610-2232
Mailing Address - Country:US
Mailing Address - Phone:724-516-5641
Mailing Address - Fax:
Practice Address - Street 1:137 MATHEWS ST
Practice Address - Street 2:STE 2100
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6940
Practice Address - Country:US
Practice Address - Phone:724-420-5297
Practice Address - Fax:724-289-1839
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor