Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 6262 | TX |
NPI | 1003850264 |
---|---|
Provider Name | Dave Wayne Tuck |
First Address | Whiteslboro, TX 76273 |
Second Address | Whitesboro, TX 76273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |