Provider Demographics
NPI:1669533626
Name:BUCKLEY, JOSEPH MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
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 1:18501 PINES BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1414
Mailing Address - Country:US
Mailing Address - Phone:954-432-3343
Mailing Address - Fax:954-450-2565
Practice Address - Street 1:18501 PINES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1414
Practice Address - Country:US
Practice Address - Phone:954-432-3343
Practice Address - Fax:954-450-2565
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor