Healthcare Provider Details

I. General information

NPI: 1609830124
Provider Name (Legal Business Name): LARRY ALAN BUCK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WEST ST
IOLA KS
66749-2803
US

IV. Provider business mailing address

103 WEST ST
IOLA KS
66749-2803
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-7711
  • Fax: 620-365-7289
Mailing address:
  • Phone: 620-365-7711
  • Fax: 620-365-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberC-3807
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: