Provider Demographics
NPI:1487607636
Name:TUCKER, THOMAS STUARD (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STUARD
Last Name:TUCKER
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 1:3 WEST 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4451
Mailing Address - Country:US
Mailing Address - Phone:308-234-2575
Mailing Address - Fax:308-237-2136
Practice Address - Street 1:3 WEST 27TH STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4451
Practice Address - Country:US
Practice Address - Phone:308-234-2575
Practice Address - Fax:308-237-2136
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063683000Medicaid
NE47063683000Medicaid
091487Medicare PIN