Provider Demographics
NPI:1730369505
Name:EMERSON, TUCKER ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:TUCKER
Middle Name:ANTHONY
Last Name:EMERSON
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 1:2443 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6275
Mailing Address - Country:US
Mailing Address - Phone:920-246-8470
Mailing Address - Fax:
Practice Address - Street 1:445 CARDINAL LN STE 106
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-9577
Practice Address - Country:US
Practice Address - Phone:920-246-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4342-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor