Provider Demographics
NPI:1356467435
Name:DR. KELLY A. BUCKLEY, D.C., LLC
Entity Type:Organization
Organization Name:DR. KELLY A. BUCKLEY, D.C., LLC
Other - Org Name:BUCKLEY FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR - MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-754-4333
Mailing Address - Street 1:755 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1710
Mailing Address - Country:US
Mailing Address - Phone:631-754-4333
Mailing Address - Fax:631-754-3833
Practice Address - Street 1:755 PULASKI RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1710
Practice Address - Country:US
Practice Address - Phone:631-754-4333
Practice Address - Fax:631-754-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009978-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty