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General NPI Number Information
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NPI Number | 1497513857
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Entity Type | Individual
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Provider Name | JONATHAN TUCKER
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Gender | Male
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 321 RIVER ST
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City | DURYEA
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State | PA
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Zip | 18642-1001
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Country | US
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Telephone | 570-299-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 321 RIVER ST
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City | DURYEA
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State | PA
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Zip | 18642-1001
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Country | US
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Telephone | 570-299-1525
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | STUDENT
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License Number State | NC
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