Provider Demographics
NPI:1003987769
Name:TUCK CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:TUCK CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING & CLAIMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-6900
Mailing Address - Street 1:620 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3385
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:540-951-8900
Practice Address - Street 1:620 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3385
Practice Address - Country:US
Practice Address - Phone:540-951-6900
Practice Address - Fax:540-951-1202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUCK CHIROPRACTIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU79143Medicare UPIN
VA00V128T58Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID.
VAU69341Medicare UPIN
VA00V127T58Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID