Provider Demographics
NPI:1982885778
Name:TUCKER, MICHELLE AGNES (LAC, ND, CH)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AGNES
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LAC, ND, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FOX TROT DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2307
Mailing Address - Country:US
Mailing Address - Phone:412-926-8019
Mailing Address - Fax:724-553-5159
Practice Address - Street 1:103 FOX TROT DR
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2307
Practice Address - Country:US
Practice Address - Phone:412-926-8019
Practice Address - Fax:724-553-5159
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000115171100000X
175F00000X
AZ03-710175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath