Provider Demographics
NPI:1376848465
Name:HOPP, TUCKER R (LAC)
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:R
Last Name:HOPP
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9574 LAKE SHORE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2644
Mailing Address - Country:US
Mailing Address - Phone:206-940-2879
Mailing Address - Fax:
Practice Address - Street 1:9574 LAKE SHORE BLVD NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2644
Practice Address - Country:US
Practice Address - Phone:206-940-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60201869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist