DR. GERARD KEVIN BUCKLEY, D.C. - NPI NUMBER 1538283833

Summary

Provider Name: DR. GERARD KEVIN BUCKLEY, D.C.

NPI Number: 1538283833

Clasification: Chiropractor (111N00000X)

Address:
2765 REBECCA LN
STE. D
ORANGE CITY, FL
ZIP 32763

Phone Number: (386) 775-1422



Detailed Information

DR. Gerard Kevin Buckley, D.C. is a chiropractor in Orange City, FL with 36 years of experience. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. The assigned NPI number for this provider is 1538283833 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: NEW YORK CHIROPRACTIC COLLEGE
Graduation Year: 1978

The provider's business address is:

2765 REBECCA LN
STE. D
ORANGE CITY, FL
ZIP 32763-326
Phone: (386) 775-1422
Fax: (386) 775-1415

The enumeration date for this NPI number is 3/19/2007 and was last updated on 5/15/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 111N00000X Chiropractor CH8641 FL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 U 1750 MEDICARE ID-TYPE UNSPECIFIED FL
2 000043400 MEDICAID FL

NPI Record

No. Field Name Field Value
1 NPI 1538283833
2 Entity Type Code 1
3 Provider Last Name Legal Name BUCKLEY
4 Provider First Name GERARD
5 Provider Middle Name KEVIN
6 Provider Name Prefix Text DR.
7 Provider Credential Text D.C.
8 Provider First Line Business Practice Location Address 2765 REBECCA LN
9 Provider Second Line Business Practice Location Address STE. D
10 Provider Business Practice Location Address City Name ORANGE CITY
11 Provider Business Practice Location Address State Name FL
12 Provider Business Practice Location Address Postal Code 327638326
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 3867751422
15 Provider Business Practice Location Address Fax Number 3867751415
16 Provider Enumeration Date 3/19/2007
17 Last Update Date 5/15/2014
18 Provider Gender Code M
19 Healthcare Provider Taxonomy Code 1 111N00000X
20 Provider License Number 1 CH8641
21 Provider License Number State Code 1 FL
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 U 1750
24 Other Provider Identifier Type Code 1 04
25 Other Provider Identifier State 1 FL
26 Other Provider Identifier 2 000043400
27 Other Provider Identifier Type Code 2 05
28 Other Provider Identifier State 2 FL
29 Is Sole Proprietor Y

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.