Organization
MESA OUTPATIENT TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BUCKNER DC (MBR)
(480) 272-8944
Entity
Organization
Contact information
Practice address
4540 E BASELINE RD STE 119, MESA, AZ 85206
(480) 272-8944
Mailing address
4540 E BASELINE RD STE 119, MESA, AZ 85206-4617
(480) 272-8944
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
06/29/2017
Last updated
07/21/2022
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