Provider Demographics
NPI:1922334085
Name:TUCKER, KESSA (DC)
Entity Type:Individual
Prefix:
First Name:KESSA
Middle Name:
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:PO BOX 890184
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0184
Mailing Address - Country:US
Mailing Address - Phone:405-759-2345
Mailing Address - Fax:405-759-3874
Practice Address - Street 1:10001 S PENNSYLVANIA AVE
Practice Address - Street 2:BLDG P SUITE 170
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6923
Practice Address - Country:US
Practice Address - Phone:405-759-2345
Practice Address - Fax:405-759-3874
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor