Provider Demographics
NPI:1952160319
Name:BUCHALTER, COREY BRANDON (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:BRANDON
Last Name:BUCHALTER
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 1:362 GULF BREEZE PKWY # 138
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4492
Mailing Address - Country:US
Mailing Address - Phone:850-454-8148
Mailing Address - Fax:
Practice Address - Street 1:18 VIA DELUNA DRIVE
Practice Address - Street 2:303A
Practice Address - City:PENSACOLA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-454-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor