Provider Demographics
NPI:1417463480
Name:AMEDI, REWAN
Entity Type:Individual
Prefix:DR
First Name:REWAN
Middle Name:
Last Name:AMEDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ELM HILL PIKE STE I
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3155
Mailing Address - Country:US
Mailing Address - Phone:616-889-1941
Mailing Address - Fax:
Practice Address - Street 1:2601 ELM HILL PIKE STE I
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3155
Practice Address - Country:US
Practice Address - Phone:615-889-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor