Provider Demographics
NPI:1700927464
Name:JOHN O TUCKER DC PA
Entity type:Organization
Organization Name:JOHN O TUCKER DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-682-4182
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty