Provider Demographics
NPI:1083872485
Name:TUCKER WELLNESS CENTER INC
Entity Type:Organization
Organization Name:TUCKER WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-536-3113
Mailing Address - Street 1:4006 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2807
Mailing Address - Country:US
Mailing Address - Phone:770-536-3113
Mailing Address - Fax:770-536-3113
Practice Address - Street 1:4006 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2807
Practice Address - Country:US
Practice Address - Phone:770-536-3113
Practice Address - Fax:770-536-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty