Provider Demographics
NPI:1619047024
Name:BUCKLEY, ROBERT K (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:K
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1418 WAYNE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-7777
Mailing Address - Fax:215-321-4750
Practice Address - Street 1:680 HEACOCK RD.
Practice Address - Street 2:SUITE 204
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-7777
Practice Address - Fax:215-321-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
607839Medicare UPIN