Individual
DR. GLENN M TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
208 SOUTH WILLIAMS STREET, JAMESPORT, MO 64648-0133
(660) 684-6161
(660) 684-6334
Mailing address
PO BOX 133, JAMESPORT, MO 64648-0133
(660) 684-6161
(660) 684-6334
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
003978
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11690032
CAQH
MO
Enumeration date
03/12/2007
Last updated
11/10/2011
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