Provider Demographics
NPI:1376712505
Name:REDUS CHIROPRACTIC CARE, INC.
Entity Type:Organization
Organization Name:REDUS CHIROPRACTIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLEVELAND
Authorized Official - Last Name:REDUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:423-566-4215
Mailing Address - Street 1:302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2935
Mailing Address - Country:US
Mailing Address - Phone:423-566-4215
Mailing Address - Fax:423-566-5155
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2935
Practice Address - Country:US
Practice Address - Phone:423-566-4215
Practice Address - Fax:423-566-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 740261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12786OtherCARITEN PREFERRED
TN3675808Medicaid
TN4026838OtherBLUE CROSS/TENNESSEE
TN3675808Medicaid
TN3675808Medicaid
TN========= 00OtherCRA MANAGED CARE