Provider Demographics
NPI:1255924684
Name:BUBANIC, TROY (DC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:BUBANIC
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 1:4082 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2866
Mailing Address - Country:US
Mailing Address - Phone:330-491-8100
Mailing Address - Fax:330-491-8147
Practice Address - Street 1:4082 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2866
Practice Address - Country:US
Practice Address - Phone:330-491-8100
Practice Address - Fax:330-491-8147
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor