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General NPI Number Information
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NPI Number | 1770601874
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Entity Type | Organization
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Legal Business Name | WAYNE TUCKER DO, PA
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 100 BECKS WOODS DR SUITE 202
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City | BEAR
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State | DE
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Zip | 19701-3835
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Country | US
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Telephone | 302-838-1100
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Fax | 302-838-8962
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Provider Business Mailing Address
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Address Line | 101 BECKS WOODS DR SUITE 100
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City | BEAR
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State | DE
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Zip | 19701
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Country | US
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Telephone | 302-838-1100
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Fax | 302-838-8962
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAYNE IRA TUCKER
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Credential | DO, PA
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Telephone | 302-838-1100
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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 | F1-0000484
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C2004133
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License Number State | DE
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