Provider Demographics
NPI:1295018919
Name:KD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KD CHIROPRACTIC LLC
Other - Org Name:METRO CENTER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-897-3300
Mailing Address - Street 1:PO BOX 11180
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0020
Mailing Address - Country:US
Mailing Address - Phone:480-264-3744
Mailing Address - Fax:480-264-2075
Practice Address - Street 1:10046 N METRO PKWY W
Practice Address - Street 2:STE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1437
Practice Address - Country:US
Practice Address - Phone:602-674-5515
Practice Address - Fax:602-674-3029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KD CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-20
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty