Provider Demographics
NPI:1609830124
Name:BUCK, LARRY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALAN
Last Name:BUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WEST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-2803
Mailing Address - Country:US
Mailing Address - Phone:620-365-7711
Mailing Address - Fax:620-365-7289
Practice Address - Street 1:103 WEST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2803
Practice Address - Country:US
Practice Address - Phone:620-365-7711
Practice Address - Fax:620-365-7289
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-3807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023690OtherBCBS
KS023690Medicare ID - Type Unspecified
KS023690Medicare UPIN