Healthcare Provider Details

I. General information

NPI: 1871563288
Provider Name (Legal Business Name): PATRICIA DIANE BUCK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 COURT ST
SAVANNAH MO
64485-1652
US

IV. Provider business mailing address

424 COURT ST
SAVANNAH MO
64485-1652
US

V. Phone/Fax

Practice location:
  • Phone: 816-324-5307
  • Fax:
Mailing address:
  • Phone: 816-324-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006231
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: