Individual
MR. JACOB WILLIAM TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
800 E LOCUST ST, OLNEY, IL 62450-2553
(618) 395-2131
(618) 395-6289
Mailing address
800 E LOCUST ST, OLNEY, IL 62450-2553
(618) 395-2131
(618) 395-6289
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.002692
IL
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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