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General NPI Number Information
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NPI Number | 1285787127
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Entity Type | Organization
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Legal Business Name | BUCKNER 30 CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3040 N BUCKNER BLVD SUITE 102
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City | DALLAS
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State | TX
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Zip | 75228-5282
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Country | US
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Telephone | 214-660-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 VETERANS BLVD SUITE 200
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City | KENNER
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State | LA
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Zip | 70062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECTUIVE ASSISTANT
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Name | BUFFIE L ROME IV
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Credential |
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Telephone | 504-467-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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