Provider Demographics
NPI:1184332934
Name:BUCKLEY, JESSIE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 ISLAND PARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7447
Mailing Address - Country:US
Mailing Address - Phone:843-972-8187
Mailing Address - Fax:
Practice Address - Street 1:866 ISLAND PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7447
Practice Address - Country:US
Practice Address - Phone:843-972-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor