Provider Demographics
NPI:1023169539
Name:TUCKER, JOHN O (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:O
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 1:202 ALLAMANDA DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2928
Mailing Address - Country:US
Mailing Address - Phone:863-682-4182
Mailing Address - Fax:863-682-7319
Practice Address - Street 1:202 ALLAMANDA DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2928
Practice Address - Country:US
Practice Address - Phone:863-682-4182
Practice Address - Fax:863-682-7319
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350053678OtherRAIL ROAD MEDICARE
4407759OtherAETNA
FL89514OtherBLUE CROSS BLUE SHIELD
FL0507164-00Medicaid
45163OtherBCBS HEALTH OPTIONS
FL109435OtherAMERIGROUP
189493OtherSTAYWELL
FL272544OtherAVMED
189493OtherWELLCARE
350053678OtherRAIL ROAD MEDICARE