MEDICARE: DR. STEPHANIE LYNN TUCKER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR007981	GA

General Provider Information

NPI Number	:	1023088267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LYNN TUCKER DC

Provider Business Mailing Address
First Line	:	3901 ROSWELL RD
Second Line	:	SUITE 208
City	:	MARIETTA
State	:	GA
Zip	:	30062-8809
Country	:	US
Telephone Number	:	770-509-9717
Fax Number	:	770-509-8796

Provider Business Practice Location Address
First Line	:	3901 ROSWELL RD
Second Line	:	SUITE 208
City	:	MARIETTA
State	:	GA
Zip	:	30062-8809
Country	:	US
Telephone Number	:	770-509-9717
Fax Number	:	770-509-8796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/10/2019

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