Provider Demographics
NPI:1154439925
Name:BUCKLEY, JAMES PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:BUCKLEY
Suffix:
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 1:412 COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856
Mailing Address - Country:US
Mailing Address - Phone:207-236-8486
Mailing Address - Fax:207-236-8472
Practice Address - Street 1:412 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4406
Practice Address - Country:US
Practice Address - Phone:207-236-8486
Practice Address - Fax:207-236-8472
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U78596Medicare UPIN
MEMM8117Medicare PIN