=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548873706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUNTER SAMUEL BUCKLEY DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2020
-----------------------------------------------------
Last Update Date | 08/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8928 US 70 BUS HWY W STE 700
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-4847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-553-5505
-----------------------------------------------------
Fax | 919-553-9909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8928 US 70 BUS HWY W STE 700
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-4847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-553-5505
-----------------------------------------------------
Fax | 919-553-9909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5188
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------