Individual
CASEY L TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1211 COLLEGE AVE, SANTA ROSA, CA 95404-3907
(707) 526-9355
(707) 526-9081
Mailing address
1211 COLLEGE AVE, SANTA ROSA, CA 95404-3907
(707) 526-9355
(707) 526-9081
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC 23602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC 23602
LICENSE NUMBER
CA
Enumeration date
05/18/2006
Last updated
08/29/2012
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