Provider Demographics
NPI:1316322977
Name:BUCKEYE CHOICE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BUCKEYE CHOICE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-799-6543
Mailing Address - Street 1:1300 S WATSON RD
Mailing Address - Street 2:#A106
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6303
Mailing Address - Country:US
Mailing Address - Phone:623-386-0444
Mailing Address - Fax:623-386-9879
Practice Address - Street 1:1300 S WATSON RD
Practice Address - Street 2:#A106
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6303
Practice Address - Country:US
Practice Address - Phone:623-386-0444
Practice Address - Fax:623-386-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty