Provider Demographics
NPI:1205978640
Name:BRADLY J BUXTON DC PA
Entity type:Organization
Organization Name:BRADLY J BUXTON DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-282-2525
Mailing Address - Street 1:2912 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2706
Mailing Address - Country:US
Mailing Address - Phone:336-282-2525
Mailing Address - Fax:336-282-7554
Practice Address - Street 1:2912 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2706
Practice Address - Country:US
Practice Address - Phone:336-282-2525
Practice Address - Fax:336-282-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1369OtherPARTNERS
330073OtherUNITED HEALTHCARE
NC08288OtherBCBS
NC244335OtherMEDICARE TYPE B
NC8908288Medicaid