Provider Demographics
NPI:1487935292
Name:KD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KD CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-897-3300
Mailing Address - Street 1:PO BOX 11180
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0020
Mailing Address - Country:US
Mailing Address - Phone:480-264-3744
Mailing Address - Fax:480-264-2075
Practice Address - Street 1:1001 E WARNER RD
Practice Address - Street 2:STE 107
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3224
Practice Address - Country:US
Practice Address - Phone:480-897-3300
Practice Address - Fax:480-897-3312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KD CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-07
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty