Provider Demographics
NPI:1184625469
Name:BUCK, GRANT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:JAMES
Last Name:BUCK
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 1:151 S MAIN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8950
Mailing Address - Country:US
Mailing Address - Phone:616-696-2688
Mailing Address - Fax:616-696-2663
Practice Address - Street 1:151 S MAIN
Practice Address - Street 2:SUITE 3
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8950
Practice Address - Country:US
Practice Address - Phone:616-696-2663
Practice Address - Fax:616-696-2663
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGB007557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM83400001Medicare PIN