Provider Demographics
NPI:1164315537
Name:BUCKLEY, MELANIE (LAC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 HALLAM RD
Mailing Address - Street 2:
Mailing Address - City:FRANCIS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9628
Mailing Address - Country:US
Mailing Address - Phone:512-217-6442
Mailing Address - Fax:
Practice Address - Street 1:1735 HALLAM RD
Practice Address - Street 2:
Practice Address - City:FRANCIS
Practice Address - State:UT
Practice Address - Zip Code:84036-9628
Practice Address - Country:US
Practice Address - Phone:512-217-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8268318-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist