Provider Demographics
NPI:1366416695
Name:BUCKLAR, CHARLES JR (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BUCKLAR
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2233
Mailing Address - Country:US
Mailing Address - Phone:610-779-7749
Mailing Address - Fax:610-779-4110
Practice Address - Street 1:2920 SAINT LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2233
Practice Address - Country:US
Practice Address - Phone:610-779-7749
Practice Address - Fax:610-779-4110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002659L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1320044OtherHIGHMARK BLUE SHIELD
3832026OtherAETNA HMO
1001234OtherASHN
7087479OtherAETNA PPO
2012804000OtherINDEPENDENO BLUE CROSSHMO
11446687OtherCAQH
1320044OtherHIGHMARK BLUE SHIELD