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General NPI Number Information
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NPI Number | 1578155610
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Entity Type | Organization
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Legal Business Name | TUCK CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 872 LEE HWY
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City | ROANOKE
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State | VA
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Zip | 24019-8691
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Country | US
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Telephone | 540-966-6485
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N MAIN ST STE 202
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City | BLACKSBURG
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State | VA
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Zip | 24060-3385
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Country | US
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Telephone | 540-951-6900
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Fax | 540-951-8900
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | HANNAH SHELTON
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Credential |
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Telephone | 540-951-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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