Provider Demographics
NPI:1043342306
Name:WRIGHT, BRENDA K (DC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:K
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:120 DOUGLAS LANE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7212
Mailing Address - Country:US
Mailing Address - Phone:423-360-8089
Mailing Address - Fax:
Practice Address - Street 1:120 DOUGLAS LANE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7212
Practice Address - Country:US
Practice Address - Phone:423-360-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64626Medicare UPIN
TN3971275Medicare ID - Type Unspecified