Provider Demographics
NPI:1003003476
Name:BUCK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BUCK CHIROPRACTIC, LLC
Other - Org Name:BUCK CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-962-3130
Mailing Address - Street 1:8641 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5109
Mailing Address - Country:US
Mailing Address - Phone:314-374-2503
Mailing Address - Fax:
Practice Address - Street 1:8641 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5109
Practice Address - Country:US
Practice Address - Phone:314-374-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007000246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty