Provider Demographics
NPI:1164598488
Name:TUCKER, DYAS T SR (DC)
Entity Type:Individual
Prefix:DR
First Name:DYAS
Middle Name:T
Last Name:TUCKER
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HIDDEN VALLEY POINTE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-7699
Mailing Address - Country:US
Mailing Address - Phone:770-438-8466
Mailing Address - Fax:
Practice Address - Street 1:3050 MARTIN LUTHER KING JR DR SW STE J4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1500
Practice Address - Country:US
Practice Address - Phone:404-691-8881
Practice Address - Fax:404-691-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor