Provider Demographics
NPI:1790084960
Name:TUCKER, CHAD PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:PATRICK
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N HAMPTON RD
Mailing Address - Street 2:#100
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4500
Mailing Address - Country:US
Mailing Address - Phone:972-230-8900
Mailing Address - Fax:972-230-8902
Practice Address - Street 1:712 N HAMPTON RD
Practice Address - Street 2:#100
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4500
Practice Address - Country:US
Practice Address - Phone:972-230-8900
Practice Address - Fax:972-230-8902
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor