Provider Demographics
NPI:1396014619
Name:TUCKER, HOLLY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7741 MARKET ST STE G
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9444
Mailing Address - Country:US
Mailing Address - Phone:910-821-0104
Mailing Address - Fax:
Practice Address - Street 1:7741 MARKET ST STE G
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9444
Practice Address - Country:US
Practice Address - Phone:910-821-0104
Practice Address - Fax:910-401-1459
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2546111N00000X
NC5471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I359376Medicare PIN