Provider Demographics
NPI:1972612000
Name:BUCKLEY, PHILIP BARRON (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BARRON
Last Name:BUCKLEY
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 1:80 W BALTIMORE AVE
Mailing Address - Street 2:SUITE C106
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2144
Mailing Address - Country:US
Mailing Address - Phone:610-622-8303
Mailing Address - Fax:610-622-5274
Practice Address - Street 1:80 W BALTIMORE AVE
Practice Address - Street 2:SUITE C106
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2144
Practice Address - Country:US
Practice Address - Phone:610-622-8303
Practice Address - Fax:610-622-5274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002995-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73067OtherAETNA
PA0032886000OtherIBC HMO
PAU10713Medicare UPIN
PA141114Medicare ID - Type UnspecifiedMEDICARE