Provider Demographics
NPI:1780014621
Name:KD HEALTHCARE LLC
Entity Type:Organization
Organization Name:KD HEALTHCARE LLC
Other - Org Name:WHITE ROCK HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-421-2730
Mailing Address - Street 1:1001 E WARNER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3224
Mailing Address - Country:US
Mailing Address - Phone:480-897-3300
Mailing Address - Fax:480-897-3312
Practice Address - Street 1:1001 E WARNER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3224
Practice Address - Country:US
Practice Address - Phone:480-897-3300
Practice Address - Fax:480-897-3312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KD HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-13
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty