Provider Demographics
NPI:1417268293
Name:DAVE W. TUCK, DC, PC
Entity Type:Organization
Organization Name:DAVE W. TUCK, DC, PC
Other - Org Name:TEXOMA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-564-9815
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-0248
Mailing Address - Country:US
Mailing Address - Phone:903-564-9815
Mailing Address - Fax:
Practice Address - Street 1:1041 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3575
Practice Address - Country:US
Practice Address - Phone:903-564-9815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603935Medicare PIN