Provider Demographics
NPI:1164182861
Name:BUCKLEY, TATUM (DC)
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 DELMAR WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3366
Mailing Address - Country:US
Mailing Address - Phone:203-727-7232
Mailing Address - Fax:
Practice Address - Street 1:2702 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6125
Practice Address - Country:US
Practice Address - Phone:561-775-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor