Basic Information
| Provider Information | |||||||||
| NPI: | 1710259072 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAVID B. TUCHINSKY, D.C., PLLC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WHETSTONE PL | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042177450 | ||||||||
| FaxNumber: | 9042177483 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WHETSTONE PL | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042177450 | ||||||||
| FaxNumber: | 9042177483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2012 | ||||||||
| LastUpdateDate: | 02/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEW | ||||||||
| AuthorizedOfficialFirstName: | ERICA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9045408029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH003617 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 380011300 | 05 | FL | MEDICAID |