Organization
BRC CHANDLER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BUCKNER DC (SOLE MEMBER)
(480) 930-4018
Entity
Organization
Contact information
Practice address
1475 W CHANDLER BLVD, CHANDLER, AZ 85224-6257
(480) 930-4018
Mailing address
PO BOX 11180, TEMPE, AZ 85284-0020
(480) 930-4018
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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