Provider Demographics
NPI:1053325134
Name:AUNGST, WALLACE STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:STEVEN
Last Name:AUNGST
Suffix:
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 1:2149 W EMORY RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3704
Mailing Address - Country:US
Mailing Address - Phone:865-938-6560
Mailing Address - Fax:
Practice Address - Street 1:2149 W EMORY RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3704
Practice Address - Country:US
Practice Address - Phone:865-938-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3123473Medicare PIN