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General NPI Number Information
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NPI Number | 1003850264
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Entity Type | Individual
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Provider Name | DAVE WAYNE TUCK D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 333 W SOUTH BOULDER RD STE 4
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City | LOUISVILLE
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State | CO
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Zip | 80027-1674
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Country | US
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Telephone | 720-457-9509
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Fax | 903-564-7981
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Provider Business Mailing Address
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Address Line | 333 W SOUTH BOULDER RD
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City | LOUISVILLE
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State | CO
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Zip | 80027-1673
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Country | US
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Telephone | 720-457-9509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 6262
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License Number State | TX
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