Healthcare Provider Details

I. General information

NPI: 1023787710
Provider Name (Legal Business Name): TUCKER CHIROPRACTIC-ROME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SHORTER AVE NW
ROME GA
30165-4283
US

IV. Provider business mailing address

PO BOX 723154
ATLANTA GA
31139-0154
US

V. Phone/Fax

Practice location:
  • Phone: 706-290-0408
  • Fax: 706-290-0470
Mailing address:
  • Phone: 706-290-0408
  • Fax: 706-290-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: LUCY THOMAS
Title or Position: BILLING MANAGER
Credential:
Phone: 678-428-7812