Organization
PG PRO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BUCKNER DC (SOLE OWNER)
(480) 930-4018
Entity
Organization
Contact information
Practice address
4715 STATESMEN DR STE AB, INDIANAPOLIS, IN 46250-5642
(317) 643-5865
(317) 436-7212
Mailing address
PO BOX 11180, TEMPE, AZ 85284-0020
(480) 930-4018
(480) 930-4018
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
08/25/2020
Last updated
11/05/2020
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