Healthcare Provider Details

I. General information

NPI: 1578304390
Provider Name (Legal Business Name): NATHAN BUCK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MOUNDS VIEW BLVD
MOUNDS VIEW MN
55112
US

IV. Provider business mailing address

2220 MOUNDS VIEW BLVD
MOUNDS VIEW MN
55112
US

V. Phone/Fax

Practice location:
  • Phone: 763-398-7770
  • Fax: 763-398-7771
Mailing address:
  • Phone: 763-398-7770
  • Fax: 763-398-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7231
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: