Provider Demographics
NPI:1265580559
Name:BUCKRIDGE, TROY D (DC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:BUCKRIDGE
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 1:11729 CHAPMAN HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5181
Mailing Address - Country:US
Mailing Address - Phone:865-577-2273
Mailing Address - Fax:865-577-2272
Practice Address - Street 1:11729 CHAPMAN HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5181
Practice Address - Country:US
Practice Address - Phone:865-577-2273
Practice Address - Fax:865-577-2272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001305111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70512Medicare UPIN
3824326Medicare PIN