Provider Demographics
NPI:1407843071
Name:DREYER, RUSSELL C (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:C
Last Name:DREYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5283
Mailing Address - Country:US
Mailing Address - Phone:865-977-0916
Mailing Address - Fax:865-984-3519
Practice Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5283
Practice Address - Country:US
Practice Address - Phone:865-977-0916
Practice Address - Fax:865-984-3519
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4219772OtherBCBST
TN39710463Medicare PIN
TN39710461Medicare PIN
TN39710462Medicare PIN