Provider Demographics
NPI:1083615553
Name:GWINN, WOODROW W JR (DC)
Entity Type:Individual
Prefix:
First Name:WOODROW
Middle Name:W
Last Name:GWINN
Suffix:JR
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 1:1812 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5283
Mailing Address - Country:US
Mailing Address - Phone:865-977-0916
Mailing Address - Fax:865-984-3519
Practice Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5283
Practice Address - Country:US
Practice Address - Phone:865-977-0916
Practice Address - Fax:865-984-3519
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC845111N00000X
TNDC336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN350013505OtherRAILROAD MEDICARE NUMBER
TN3674835Medicaid
TN3674838Medicaid
TN4111719OtherBCBST
TN4159000OtherBCBST
TN3072063OtherBCBST
TN97802OtherBCBST
TN350013505OtherRAILROAD MEDICARE NUMBER
TN4111719OtherBCBST
TN3723209Medicare PIN