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NPI Code Detail

MEDICARE: DR. MATTHEW JAMES BUCK D.C.

MEDICARE: DR. MATTHEW 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
1111N00000XChiropractor2007000246MO

General Provider Information

NPI Number : 1417162512
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JAMES BUCK D.C.
Provider Business Mailing Address
First Line : 8641 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-5109
Country : US
Telephone Number : 314-962-3130
Fax Number :
Provider Business Practice Location Address
First Line : 8641 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-5109
Country : US
Telephone Number : 314-962-3130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 07/22/2014

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