MEDICARE: DR. GRANT JAMES BUCK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	GB007557	MI

General Provider Information

NPI Number	:	1184625469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRANT JAMES BUCK D.C.

Provider Business Mailing Address
First Line	:	151 S MAIN
Second Line	:	SUITE 4
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-8950
Country	:	US
Telephone Number	:	616-696-2688
Fax Number	:	616-696-2663

Provider Business Practice Location Address
First Line	:	151 S MAIN
Second Line	:	SUITE 3
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-8950
Country	:	US
Telephone Number	:	616-696-2663
Fax Number	:	616-696-2663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/01/2008

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