Provider Demographics
NPI:1366468993
Name:WINGATE, SHERI DENISE (DC)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:DENISE
Last Name:WINGATE
Suffix:
Gender:F
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:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-0736
Mailing Address - Country:US
Mailing Address - Phone:423-538-4000
Mailing Address - Fax:423-538-8144
Practice Address - Street 1:5661 HIGHWAY 11 E
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4462
Practice Address - Country:US
Practice Address - Phone:423-538-4000
Practice Address - Fax:423-538-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3675797Medicaid
TN3055482OtherBLUE CROSS PROVIDER NUMBE
TN3675797Medicaid
TNU16354Medicare UPIN