Provider Demographics
NPI:1396441564
Name:BUCHANAN, TIMONIA MARIZDELLE (DC)
Entity type:Individual
Prefix:
First Name:TIMONIA
Middle Name:MARIZDELLE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12325 SHADOW CREEK PKWY APT 16209
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7436
Mailing Address - Country:US
Mailing Address - Phone:561-889-9304
Mailing Address - Fax:
Practice Address - Street 1:12155 SHADOW CREEK PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7289
Practice Address - Country:US
Practice Address - Phone:832-243-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty