Organization
LAKESHORE UNITED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BUCKNER DC (SOLE MEMBER)
(602) 421-2730
Entity
Organization
Contact information
Practice address
4765 S LAKESHORE DR, TEMPE, AZ 85282-7197
(480) 646-3258
Mailing address
PO BOX 11180, TEMPE, AZ 85284-0020
(480) 646-3258
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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