MEDICARE: MR. GEORGE LEE BUCKLER JR. 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	5220 D.C. & 2945 PT	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0933910	OTHER	AZ	BCBS AZ PROVIDER NUMBER

General Provider Information

NPI Number	:	1528137924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE LEE BUCKLER JR. D.C.

Provider Business Mailing Address
First Line	:	4747 E ELLIOT ROAD
Second Line	:	SUITE 32
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1630
Country	:	US
Telephone Number	:	480-893-8700
Fax Number	:	480-893-1300

Provider Business Practice Location Address
First Line	:	4747 E ELLIOT ROAD
Second Line	:	SUITE 32
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1630
Country	:	US
Telephone Number	:	480-893-8700
Fax Number	:	480-893-1300

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/09/2007

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Directions to “ MR. GEORGE LEE BUCKLER JR. D.C.” Practice Location

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