=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770636797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUCKNER CHIROPRACTIC CENTER, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 W HIGHWAY 146
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-265-0184
-----------------------------------------------------
Fax | 502-265-0184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 373
-----------------------------------------------------
City | BUCKNER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40010-0373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-265-0184
-----------------------------------------------------
Fax | 502-265-0184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. REBECCA JEAN SHELBURNE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 502-265-0184
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 4155
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------