Provider Demographics
NPI:1144253469
Name:BEARDEN HEALTHCARE ASSOCIATES INC
Entity type:Organization
Organization Name:BEARDEN HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-584-3565
Mailing Address - Street 1:10321 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3224
Mailing Address - Country:US
Mailing Address - Phone:865-584-3565
Mailing Address - Fax:865-584-2956
Practice Address - Street 1:10321 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3224
Practice Address - Country:US
Practice Address - Phone:865-584-3565
Practice Address - Fax:865-584-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000705111N00000X
TNDC0000000766111N00000X
TNMD53866207LP2900X, 207L00000X
TNMD0000016119207Q00000X
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971651Medicaid
TN7379550001OtherDURABLE MEDICAL EQUIPMENT
TN3717202Medicare PIN
TN7379550001Medicare PIN