Individual provider Active NPI

Louis J Buffalino, DC

  • Chiropractor
  • Wilmington, NC
National Provider Identifier
1073629101
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
909CHI Issued in MT
Practice address
1133 Military Cutoff Rd
Ste 110
Wilmington, NC 28405-4403
Phone
(406) 222-4444
Fax
(406) 222-9796
NPI assigned
Aug 22, 2006
Last updated
Jul 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 909CHI MT Primary

Addresses

Primary practice location

1133 Military Cutoff Rd
Ste 110
Wilmington, NC 28405-4403

Mailing address

1133 Military Cutoff Rd
Ste 110
Wilmington, NC 28405-4403
Phone (406) 222-4444

Other identifiers 1

IdentifierTypeStateIssuer
0164125MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160815001110 NC Practitioner - Chiropractic 7911058995

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4649NCMDMental Health Counselor
909CHIMTMDChiropractor
909MTMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Revivify Chiropractic Wellness Center CurrentSince Jan 30, 2024 Accepting new patients
Nohl P.C. PastSince Jun 2, 2015 Accepting new patients
Ryan Herold P.C. Chiropractor PastSince Dec 24, 2023 Accepting new patients

Locations

3528 Adirondack Way
Ste 120
Wilmington, NC 28403
Phone (910) 679-4079

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1073629101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MILITARY CUTOFF RD",
            "address_2": "STE 110",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284054403",
            "telephone_number": "406-222-4444",
            "fax_number": "406-222-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 MILITARY CUTOFF RD",
            "address_2": "STE 110",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284054403",
            "telephone_number": "406-222-4444",
            "fax_number": "406-222-9796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUFFALINO",
        "first_name": "LOUIS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MT",
            "license": "909CHI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0164125",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.