Provider Demographics
NPI:1275324006
Name:BUCKLEY, CARLIE (L AC)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 S SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2543
Mailing Address - Country:US
Mailing Address - Phone:414-336-5945
Mailing Address - Fax:
Practice Address - Street 1:4433 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1600
Practice Address - Country:US
Practice Address - Phone:414-481-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist