Provider Demographics
NPI:1245559657
Name:ESTES FAMILY CHIROPRACTIC AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:ESTES FAMILY CHIROPRACTIC AND WELLNESS CLINIC
Other - Org Name:ESTES FAMILY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-657-9941
Mailing Address - Street 1:702 GROVE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1481
Mailing Address - Country:US
Mailing Address - Phone:865-657-9941
Mailing Address - Fax:865-657-9942
Practice Address - Street 1:702 GROVE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1481
Practice Address - Country:US
Practice Address - Phone:865-657-9941
Practice Address - Fax:865-657-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty