Healthcare Provider Details

I. General information

NPI: 1740738210
Provider Name (Legal Business Name): TUCKER CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S WILLIAMS ST
JAMESPORT MO
64648
US

IV. Provider business mailing address

208 S WILLIAMS ST P.O. BOX 133
JAMESPORT MO
64648
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2016030812
License Number StateMO

VIII. Authorized Official

Name: DR. HUNTER WHITE
Title or Position: ORGANIZER
Credential: D.C.
Phone: 816-752-2479