Provider Demographics
NPI:1366268328
Name:TUCK, NATHANIEL RAY III (DC)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:RAY
Last Name:TUCK
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3385
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:
Practice Address - Street 1:620 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3385
Practice Address - Country:US
Practice Address - Phone:540-951-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104558036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor