Healthcare Provider Details

I. General information

NPI: 1780014621
Provider Name (Legal Business Name): KD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E WARNER RD SUITE 107
TEMPE AZ
85284-3224
US

IV. Provider business mailing address

1001 E WARNER RD SUITE 107
TEMPE AZ
85284-3224
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-3300
  • Fax: 480-897-3312
Mailing address:
  • Phone: 480-897-3300
  • Fax: 480-897-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEREMY R BUCKNER
Title or Position: OWNER
Credential: D.C.
Phone: 602-421-2730