MEDICARE: JONATHAN TUCKER

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	111N00000X	Chiropractor	STUDENT	NC

General Provider Information

NPI Number	:	1497513857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN TUCKER

Provider Business Mailing Address
First Line	:	1160 EAST CUTLAR CROSSING
Second Line	:	UNIT 110
City	:	LELAND
State	:	NC
Zip	:	28451
Country	:	US
Telephone Number	:	910-371-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 EAST CUTLAR CROSSING
Second Line	:	UNIT 110
City	:	LELAND
State	:	NC
Zip	:	28451
Country	:	US
Telephone Number	:	910-371-1200
Fax Number	:

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	02/12/2026

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Directions to “ JONATHAN TUCKER ” Practice Location

Language	Start Address	Practice Location

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