Healthcare Provider Details

I. General information

NPI: 1578155610
Provider Name (Legal Business Name): TUCK CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 LEE HWY
ROANOKE VA
24019-8691
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 540-966-6485
  • Fax:
Mailing address:
  • Phone: 540-951-6900
  • Fax: 540-951-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HANNAH SHELTON
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 540-951-6900