Provider Demographics
NPI:1073755575
Name:TENNESSEE VALLEY CLINIC OF CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TENNESSEE VALLEY CLINIC OF CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-775-6688
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0996
Mailing Address - Country:US
Mailing Address - Phone:423-775-6688
Mailing Address - Fax:423-775-8777
Practice Address - Street 1:304 1ST AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1290
Practice Address - Country:US
Practice Address - Phone:423-775-6688
Practice Address - Fax:423-775-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002218261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service