Healthcare Provider Details

I. General information

NPI: 1467364307
Provider Name (Legal Business Name): TYCE HUCK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N DESLOGE DR
DESLOGE MO
63601-2937
US

IV. Provider business mailing address

1110 N DESLOGE DR
DESLOGE MO
63601-2937
US

V. Phone/Fax

Practice location:
  • Phone: 573-518-0608
  • Fax: 573-518-0635
Mailing address:
  • Phone: 573-518-0608
  • Fax: 573-518-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2026045241
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: