Provider Demographics
NPI:1699028894
Name:BUCK, ERIC (ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BUCK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 EASTON LN APT 105
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4861
Mailing Address - Country:US
Mailing Address - Phone:815-388-2229
Mailing Address - Fax:
Practice Address - Street 1:2534 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9712
Practice Address - Country:US
Practice Address - Phone:815-462-9420
Practice Address - Fax:815-462-9421
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960025492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer