1073564753 NPI number — TUCKER CHIROPRACTIC, A PROFESSIONAL CORPORATION

Table of content: EDUARDO GARCIA II MSW (NPI 1184503963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073564753 NPI number — TUCKER CHIROPRACTIC, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUCKER CHIROPRACTIC, A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073564753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95404-3907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-526-9355
Provider Business Mailing Address Fax Number:
707-526-9081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95404-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-526-9355
Provider Business Practice Location Address Fax Number:
707-526-9081
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
CASEY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
707-526-9355

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  COR2838 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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