Healthcare Provider Details

I. General information

NPI: 1003987769
Provider Name (Legal Business Name): TUCK CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST STE 203
BLACKSBURG VA
24060-3385
US

IV. Provider business mailing address

620 N MAIN ST STE 202
BLACKSBURG VA
24060-3385
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-6900
  • Fax: 540-951-1202
Mailing address:
  • Phone: 540-951-6900
  • Fax: 540-951-8900

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

VIII. Authorized Official

Name: HANNAH SHELTON
Title or Position: BILLING & CLAIMS COORDINATOR
Credential:
Phone: 540-951-6900