Provider Demographics
NPI:1003209180
Name:SPORT AND WELLNESS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:SPORT AND WELLNESS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DANDELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-219-3570
Mailing Address - Street 1:10426 JACKSON OAKS WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-0711
Mailing Address - Country:US
Mailing Address - Phone:865-219-3570
Mailing Address - Fax:
Practice Address - Street 1:10426 JACKSON OAKS WAY
Practice Address - Street 2:STE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0711
Practice Address - Country:US
Practice Address - Phone:865-219-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty