Provider Demographics
NPI:1598806754
Name:BUCKLEY, RANDALL E (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:BUCKLEY
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 1:917 E KANSAS PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5861
Mailing Address - Country:US
Mailing Address - Phone:620-275-1221
Mailing Address - Fax:
Practice Address - Street 1:917 E KANSAS PLZ
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5861
Practice Address - Country:US
Practice Address - Phone:620-275-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060893OtherBCBS IND. NUMBER
KS060893Medicare ID - Type UnspecifiedMEDICARE IND. NUMBER
KSU44148Medicare UPIN