Provider Demographics
NPI:1770636797
Name:BUCKNER CHIROPRACTIC CENTER, PSC
Entity Type:Organization
Organization Name:BUCKNER CHIROPRACTIC CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHELBURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-265-0184
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:KY
Mailing Address - Zip Code:40010-0373
Mailing Address - Country:US
Mailing Address - Phone:502-265-0184
Mailing Address - Fax:502-265-0184
Practice Address - Street 1:4201 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9758
Practice Address - Country:US
Practice Address - Phone:502-265-0184
Practice Address - Fax:502-265-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4155261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4480965OtherAETNA
KY000000318051OtherBLUE CROSS BLUE SHIELD
KY6066901Medicare ID - Type Unspecified