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General NPI Number Information
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NPI Number | 1750519518
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Entity Type | Individual
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Provider Name | EMMET CLIVE TUCKER L.AC.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 1111 S OCEAN BLVD APT 419
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City | BOCA RATON
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State | FL
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Zip | 33432-7659
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Country | US
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Telephone | 808-283-2105
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S OCEAN BLVD APT 419
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City | BOCA RATON
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State | FL
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Zip | 33432-7659
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Country | US
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Telephone | 808-283-2105
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 883
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License Number State | HI
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