# LAKESHORE UNITED LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902446495
- **Authorized official:** JEREMY BUCKNER DC (SOLE MEMBER)
- **Authorized official phone:** (602) 421-2730

## Contact information

- **Practice address:** 4765 S LAKESHORE DR, TEMPE, AZ 85282-7197
- **Practice address phone:** (480) 646-3258
- **Mailing address:** PO BOX 11180, TEMPE, AZ 85284-0020
- **Mailing address phone:** (480) 646-3258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 01/13/2020
- **Last updated:** 01/13/2020