1255436341 NPI number — DR. AMY FREDERICK BUCK D.C.

Table of content: DR. AMY FREDERICK BUCK D.C. (NPI 1255436341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255436341 NPI number — DR. AMY FREDERICK BUCK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCK
Provider First Name:
AMY
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREDERICK
Provider Other First Name:
AMY
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255436341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 BYRON RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48843-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-552-3132
Provider Business Mailing Address Fax Number:
517-552-8463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 BYRON RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-552-3132
Provider Business Practice Location Address Fax Number:
517-552-8463
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301007587 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005986696 . This is a "AETNA ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2301007587 . This is a "LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 133263 . This is a "PREFERRED CHOICE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4242251 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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