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General NPI Number Information
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NPI Number | 1952433013
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Entity Type | Individual
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Provider Name | GLENN M TUCKER DC
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 208 SOUTH WILLIAMS STREET
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City | JAMESPORT
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State | MO
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Zip | 64648-0133
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Country | US
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Telephone | 660-684-6161
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Fax | 660-684-6334
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Provider Business Mailing Address
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Address Line | PO BOX 133
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City | JAMESPORT
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State | MO
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Zip | 64648-0133
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Country | US
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Telephone | 660-684-6161
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Fax | 660-684-6334
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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 | 003978
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License Number State | MO
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