MEDICARE: BUCKLER CHIROPRACTIC GROUP LLC

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	111NR0400X	Rehabilitation Chiropractor	D.C.5220, PHYSIOTHER	AZ

General Provider Information

NPI Number	:	1689867061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKLER CHIROPRACTIC GROUP LLC

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	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. GEORGE LEE BUCKLER JR.
Credential	:	D.C.
Telephone Number	:	480-893-8700

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	09/11/2007

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