Provider Demographics
NPI:1710001896
Name:BUECKMAN, KEVIN W (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:BUECKMAN
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 1:515 NORTH SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9407
Mailing Address - Country:US
Mailing Address - Phone:616-891-5105
Mailing Address - Fax:
Practice Address - Street 1:653 36TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4004
Practice Address - Country:US
Practice Address - Phone:616-530-0085
Practice Address - Fax:616-531-5029
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB004130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950 D1 5107OtherBCBS PROVIDER ID
MIP52560OtherBCN PROVIDER ID
MI2117924Medicaid
MI2117924Medicaid
MI950 D1 5107OtherBCBS PROVIDER ID