Provider Demographics
NPI:1528306487
Name:TUCKER, DENNIS ROY (PHD,LAC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ROY
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PHD,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 ZION ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2923
Mailing Address - Country:US
Mailing Address - Phone:530-265-9594
Mailing Address - Fax:530-265-6171
Practice Address - Street 1:824 ZION ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2923
Practice Address - Country:US
Practice Address - Phone:530-265-9594
Practice Address - Fax:530-265-6171
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist