Provider Demographics
NPI:1780612929
Name:BUCKLEY, SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:712 S PETTY ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2254
Mailing Address - Country:US
Mailing Address - Phone:434-203-9373
Mailing Address - Fax:
Practice Address - Street 1:212 S GRANARD ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2347
Practice Address - Country:US
Practice Address - Phone:864-487-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00030012Medicaid
VA00030012Medicaid
VAU77673Medicare UPIN