Provider Demographics
NPI:1447317870
Name:TUCK CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:TUCK CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TUCK JR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-951-6900
Mailing Address - Street 1:65 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5058
Mailing Address - Country:US
Mailing Address - Phone:540-980-8353
Mailing Address - Fax:
Practice Address - Street 1:65 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5058
Practice Address - Country:US
Practice Address - Phone:540-980-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty