1548619497 NPI number — DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC

Table of content: (NPI 1548619497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548619497 NPI number — DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548619497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9740 ROYAL CHARTRES SQ N
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38018-4423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-573-2526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 TRINITY CREEK CV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38018-2279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-573-2526
Provider Business Practice Location Address Fax Number:
901-614-2523
Provider Enumeration Date:
06/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DETWEILER
Authorized Official First Name:
TYREL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
901-573-2526

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  2894 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com