Provider Demographics
NPI:1598307399
Name:BUCKLE, WESLEY THOMAS (ND)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:THOMAS
Last Name:BUCKLE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41608 INDIAN TRL STE D2
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4519
Mailing Address - Country:US
Mailing Address - Phone:760-278-1887
Mailing Address - Fax:
Practice Address - Street 1:41608 INDIAN TRL STE D2
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4519
Practice Address - Country:US
Practice Address - Phone:760-278-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1085175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath