Provider Demographics
NPI:1346947215
Name:HERUM, JEREMY (MS, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HERUM
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CITYGREEN WAY APT 314
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1484
Mailing Address - Country:US
Mailing Address - Phone:706-994-9190
Mailing Address - Fax:
Practice Address - Street 1:230 CITYGREEN WAY APT 314
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1484
Practice Address - Country:US
Practice Address - Phone:706-994-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TN30822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer