Healthcare Provider Details

I. General information

NPI: 1770636797
Provider Name (Legal Business Name): BUCKNER CHIROPRACTIC CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W HIGHWAY 146
LA GRANGE KY
40031-9758
US

IV. Provider business mailing address

PO BOX 373
BUCKNER KY
40010-0373
US

V. Phone/Fax

Practice location:
  • Phone: 502-265-0184
  • Fax: 502-265-0184
Mailing address:
  • Phone: 502-265-0184
  • Fax: 502-265-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4155
License Number StateKY

VIII. Authorized Official

Name: DR. REBECCA JEAN SHELBURNE
Title or Position: PRESIDENT
Credential: DC
Phone: 502-265-0184