Organization
EXR4 MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BUCKNER DC (MEMBER)
(602) 421-2730
Entity
Organization
Contact information
Practice address
1984 E BASELINE RD, TEMPE, AZ 85283-1535
(480) 272-8944
(480) 930-4018
Mailing address
4540 E BASELINE RD STE 105, MESA, AZ 85206-4616
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/17/2019
Last updated
07/15/2020
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