MEDICARE: DAVE WAYNE TUCK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	6262	TX

General Provider Information

NPI Number	:	1003850264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVE WAYNE TUCK D.C.

Provider Business Mailing Address
First Line	:	333 W SOUTH BOULDER RD
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1673
Country	:	US
Telephone Number	:	720-457-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 W SOUTH BOULDER RD STE 4
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1674
Country	:	US
Telephone Number	:	720-457-9509
Fax Number	:	903-564-7981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/10/2024

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