Provider Demographics
NPI:1487040291
Name:BUCK, BENJAMIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:M
Last Name:BUCK
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 1:600 S AIRPORT RD
Mailing Address - Street 2:UNIT CC
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6407
Mailing Address - Country:US
Mailing Address - Phone:509-308-1201
Mailing Address - Fax:
Practice Address - Street 1:600 S AIRPORT RD
Practice Address - Street 2:UNIT CC
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6407
Practice Address - Country:US
Practice Address - Phone:303-776-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077525111N00000X
COCHR.0008055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor