Provider Demographics
NPI:1669599718
Name:BUCHANAN CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BUCHANAN CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-639-8540
Mailing Address - Street 1:17224 SE 272ND ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4953
Mailing Address - Country:US
Mailing Address - Phone:253-639-8540
Mailing Address - Fax:253-639-8542
Practice Address - Street 1:17224 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4953
Practice Address - Country:US
Practice Address - Phone:253-639-8540
Practice Address - Fax:253-639-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033827111N00000X
WAMA00020714174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB39348Medicare ID - Type Unspecified