=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417268293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVE W. TUCK, DC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2010
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 W SOUTH BOULDER RD STE 4
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-457-9509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 W SOUTH BOULDER RD STE 4
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-457-9509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVE TUCK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 903-814-5283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6262
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------