04D2157417 CLIA NUMBER - TUCKER CHIROPRACTIC CENTER, PLLC

Laboratory Demographics

CLIA Number: 04D2157417

Facility Name: TUCKER CHIROPRACTIC CENTER, PLLC

Facility Address:
1179 S GENTRY BLVD
GENTRY, AR
ZIP 72734
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Facility Phone Number: 479 736-8900

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1104848001

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	04D2157417
LAB Type	Practitioner Other
Facility Name	TUCKER CHIROPRACTIC CENTER, PLLC
Street	1179 S GENTRY BLVD
City	GENTRY
State	AR
ZIP	72734
Phone	479 736-8900
CertificateType	4
CertificateEffectiveDate	11/6/2022
CertificateExpirationDate	11/5/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024