MEDICARE: CHARLES BUCKLAR JR. DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002659L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1320044	OTHER	HIGHMARK BLUE SHIELD
2	3832026	OTHER	AETNA HMO
3	1001234	OTHER	ASHN
4	7087479	OTHER	AETNA PPO
5	2012804000	OTHER	INDEPENDENO BLUE CROSSHMO
6	11446687	OTHER	CAQH

General Provider Information

NPI Number	:	1366416695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BUCKLAR JR. DC

Provider Business Mailing Address
First Line	:	2920 SAINT LAWRENCE AVE
Second Line	:
City	:	READING
State	:	PA
Zip	:	19606-2233
Country	:	US
Telephone Number	:	610-779-7749
Fax Number	:	610-779-4110

Provider Business Practice Location Address
First Line	:	2920 SAINT LAWRENCE AVE
Second Line	:
City	:	READING
State	:	PA
Zip	:	19606-2233
Country	:	US
Telephone Number	:	610-779-7749
Fax Number	:	610-779-4110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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