Provider Demographics
NPI:1356504443
Name:ROHM, JD TUCKER (DC)
Entity Type:Individual
Prefix:
First Name:JD TUCKER
Middle Name:
Last Name:ROHM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JD TUCKER
Other - Middle Name:
Other - Last Name:ROHM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:213 S OLD PACIFIC HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-8785
Mailing Address - Country:US
Mailing Address - Phone:541-860-3000
Mailing Address - Fax:541-860-5600
Practice Address - Street 1:213 SO. OLD PACIFIC HIGHWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457
Practice Address - Country:US
Practice Address - Phone:541-860-3000
Practice Address - Fax:541-860-5600
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1270111N00000X
OR4090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor