Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2064 | SC |
NPI | 1194934935 |
---|---|
Provider Name | Dr. Amanda R Tucker |
First Address | N Charleston, SC 29406 |
Second Address | North Charleston, SC 29406-9268 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |