Provider Demographics
NPI:1528137924
Name:BUCKLER, GEORGE LEE JR (DC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LEE
Last Name:BUCKLER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4747 E ELLIOT ROAD
Mailing Address - Street 2:SUITE 32
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1630
Mailing Address - Country:US
Mailing Address - Phone:480-893-8700
Mailing Address - Fax:480-893-1300
Practice Address - Street 1:4747 E ELLIOT ROAD
Practice Address - Street 2:SUITE 32
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1630
Practice Address - Country:US
Practice Address - Phone:480-893-8700
Practice Address - Fax:480-893-1300
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5220 D.C. & 2945 PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0933910OtherBCBS AZ PROVIDER NUMBER
AZZ76435Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZ52545 MEDICMedicare UPIN