MEDICARE: BUCKNER 30 CHIROPRACTIC CLINIC, INC.

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

General Provider Information

NPI Number	:	1285787127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKNER 30 CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	1919 VETERANS BLVD
Second Line	:	SUITE 200
City	:	KENNER
State	:	LA
Zip	:	70062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 N BUCKNER BLVD
Second Line	:	SUITE 102
City	:	DALLAS
State	:	TX
Zip	:	75228-5282
Country	:	US
Telephone Number	:	214-660-0016
Fax Number	:

Authorized Official
Title or Position	:	EXECTUIVE ASSISTANT
Name	:	BUFFIE L ROME IV
Credential	:
Telephone Number	:	504-467-0302

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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