Provider Demographics
NPI:1003987769
Name:RAY TUCK D.C.,P.C.
Entity Type:Organization
Organization Name:RAY TUCK D.C.,P.C.
Other - Org Name:TUCK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING & CLAIMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-6900
Mailing Address - Street 1:1901 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6628
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:540-951-8900
Practice Address - Street 1:2045 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1227
Practice Address - Country:US
Practice Address - Phone:540-951-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY TUCK D.C.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU79143Medicare UPIN
VA00V128T58Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID.
VAU69341Medicare UPIN
VA00V127T58Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID