Healthcare Provider Details

I. General information

NPI: 1710259072
Provider Name (Legal Business Name): DAVID B. TUCHINSKY, D.C., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL SUITE 310
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

100 WHETSTONE PL SUITE 310
ST AUGUSTINE FL
32086-5774
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-7450
  • Fax: 904-217-7483
Mailing address:
  • Phone: 904-217-7450
  • Fax: 904-217-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH003617
License Number StateFL

VIII. Authorized Official

Name: ERICA M DEW
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-540-8029