Healthcare Provider Details

I. General information

NPI: 1710001896
Provider Name (Legal Business Name): KEVIN W BUECKMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 36TH ST SW
WYOMING MI
49509-4004
US

IV. Provider business mailing address

515 NORTH SE
CALEDONIA MI
49316-9407
US

V. Phone/Fax

Practice location:
  • Phone: 616-530-0085
  • Fax: 616-531-5029
Mailing address:
  • Phone: 616-891-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberKB004130
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: