Healthcare Provider Details

I. General information

NPI: 1730366535
Provider Name (Legal Business Name): TUCKER CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SOUTH WILLIAMS STREET
JAMESPORT MO
64648-0133
US

IV. Provider business mailing address

PO BOX 133
JAMESPORT MO
64648-0133
US

V. Phone/Fax

Practice location:
  • Phone: 660-684-6161
  • Fax: 660-684-6334
Mailing address:
  • Phone: 660-684-6161
  • Fax: 660-684-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0003978
License Number StateMO

VIII. Authorized Official

Name: DR. GLENN M TUCKER
Title or Position: OWNER PRESIDENT
Credential: DC
Phone: 660-684-6161