Provider Demographics
NPI:1083727895
Name:WARNER, DOUGLAS M (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:WARNER
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 1:673 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4906
Mailing Address - Country:US
Mailing Address - Phone:865-475-5684
Mailing Address - Fax:865-475-5686
Practice Address - Street 1:673 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4906
Practice Address - Country:US
Practice Address - Phone:865-475-5684
Practice Address - Fax:865-475-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00000592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3674598Medicare ID - Type Unspecified
T74686Medicare UPIN