Provider Demographics
NPI:1518224997
Name:FAMILY CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OFFICE
Other - Org Name:DR. STEPHANIE TUCKER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-509-9717
Mailing Address - Street 1:3901 ROSWELL RD
Mailing Address - Street 2:STE 208
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8809
Mailing Address - Country:US
Mailing Address - Phone:770-509-9717
Mailing Address - Fax:770-509-8796
Practice Address - Street 1:3901 ROSWELL RD
Practice Address - Street 2:STE 208
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8809
Practice Address - Country:US
Practice Address - Phone:770-509-9717
Practice Address - Fax:770-509-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty