MEDICARE: DR. GERARD KEVIN BUCKLEY 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	CH8641	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538283833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD KEVIN BUCKLEY D.C.

Provider Business Mailing Address
First Line	:	2765 REBECCA LN
Second Line	:	SUITE D
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8326
Country	:	US
Telephone Number	:	386-775-1422
Fax Number	:	386-775-1415

Provider Business Practice Location Address
First Line	:	2765 REBECCA LN
Second Line	:	STE. D
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8326
Country	:	US
Telephone Number	:	386-775-1422
Fax Number	:	386-775-1415

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/15/2014

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