# TUCKER NECK AND BACK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134355779
- **Authorized official:** DR. TONY L BANGUILAN D.C. (CEO)
- **Authorized official phone:** (770) 621-5585

## Contact information

- **Practice address:** 4880 LAWRENCEVILLE HWY, SUITE 13, TUCKER, GA 30084-2938
- **Practice address phone:** (770) 621-5585
- **Practice address fax:** (770) 414-7355
- **Mailing address:** 4880 LAWRENCEVILLE HWY, SUITE 13, TUCKER, GA 30084-2938
- **Mailing address phone:** (770) 621-5585
- **Mailing address fax:** (770) 414-7355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | CHIR0006452 | GA | Yes |

## Other

- **Enumeration date:** 06/10/2009
- **Last updated:** 06/10/2009