NPI Code Detail JSON Logo

1003850264 NPI number — DAVE WAYNE TUCK D.C.

NPI Number: 1003850264
Health Care Provider/Practitioner: DAVE WAYNE TUCK D.C.

Information about “1003850264” NPI (DAVE WAYNE TUCK D.C.) exists in 1003850264 in HTML format HTML  |  1003850264 in plain Text format TXT  |  1003850264 in PDF (Portable Document Format) PDF  |  1003850264 in an XML format XML  formats.

NPI Number : 1003850264 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003850264",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TUCK",
    "FirstName": "DAVE",
    "MiddleName": "WAYNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "333 W SOUTH BOULDER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80027-1673",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "720-457-9509",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "333 W SOUTH BOULDER RD STE 4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80027-1674",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "720-457-9509",
    "PracticeLocationAddressFaxNumber": "903-564-7981",
    "EnumerationDate": "06/16/2006",
    "LastUpdateDate": "09/10/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111NS0005X",
        "TaxonomyName": "Sports Physician Chiropractor",
        "LicenseNumber": "6262",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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