Provider Demographics
NPI:1104848001
Name:TUCKER CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:TUCKER CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:479-736-8900
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-0936
Mailing Address - Country:US
Mailing Address - Phone:479-736-8900
Mailing Address - Fax:479-736-5133
Practice Address - Street 1:1179 S GENTRY BLVD
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-9624
Practice Address - Country:US
Practice Address - Phone:479-736-8900
Practice Address - Fax:479-736-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181145718Medicaid