Healthcare Provider Details

I. General information

NPI: 1932805488
Provider Name (Legal Business Name): WILLIAM TYLER BUCKELEW DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 WARREN PKWY STE 101
FRISCO TX
75034-4165
US

IV. Provider business mailing address

312 CAMILLE XING
CELINA TX
75009-1758
US

V. Phone/Fax

Practice location:
  • Phone: 372-327-3100
  • Fax: 469-731-4723
Mailing address:
  • Phone: 903-818-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15430
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: