Provider Demographics
NPI:1053420265
Name:TUCKER, DEBORAH CAROLINE (DC)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:CAROLINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 CHASTAIN MEADOWS PKWY
Mailing Address - Street 2:130
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3369
Mailing Address - Country:US
Mailing Address - Phone:770-424-4040
Mailing Address - Fax:770-424-0051
Practice Address - Street 1:2769 CHASTAIN MEADOWS PKWY
Practice Address - Street 2:130
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3369
Practice Address - Country:US
Practice Address - Phone:770-424-4040
Practice Address - Fax:770-424-0051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5278111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDFQMedicare ID - Type UnspecifiedMEDICARE #
GAU53960Medicare UPIN