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General NPI Number Information
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NPI Number | 1831411594
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Entity Type | Organization
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Legal Business Name | M.M.S.C.;INC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 7211 US 42
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City | FLORENCE
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State | KY
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Zip | 41042-1901
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Country | US
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Telephone | 859-817-0817
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Fax | 859-817-1329
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Provider Business Mailing Address
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Address Line | 7211 US 42
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City | FLORENCE
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State | KY
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Zip | 41042-1901
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Country | US
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Telephone | 859-817-0817
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Fax | 859-817-1329
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. MARK RICHARD BUCKLES
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Credential | D.C.
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Telephone | 859-817-0817
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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 | 4937
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License Number State | KY
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