Provider Demographics
NPI:1518394253
Name:BUCKNER, ANDREW (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S FEDERAL HWY
Mailing Address - Street 2:#30
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4983
Mailing Address - Country:US
Mailing Address - Phone:954-821-7015
Mailing Address - Fax:
Practice Address - Street 1:601 S FEDERAL HWY
Practice Address - Street 2:#30
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4983
Practice Address - Country:US
Practice Address - Phone:954-821-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist