Basic Information
| Provider Information | |||||||||
| NPI: | 1811403249 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUELL | ||||||||
| FirstName: | GARRETT | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 700688 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782700688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103183007 | ||||||||
| FaxNumber: | 2104680682 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 PRIME CT STE 105 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453739045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004046050 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038013174 | IL | N | Chiropractic Providers | Chiropractor | 111N00000X | DC-04949 | OH | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | DC-04949 | 01 | OH | OHIO STATE CHIROPRACTIC BOARD | OTHER |