Provider Demographics
NPI:1689326365
Name:BUCK, MACKENZIE PAIGE (DC)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:PAIGE
Last Name:BUCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CARTWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5128
Mailing Address - Country:US
Mailing Address - Phone:304-216-9399
Mailing Address - Fax:
Practice Address - Street 1:1907 VARNER ST STE C2
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8104
Practice Address - Country:US
Practice Address - Phone:843-419-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor