Provider Demographics
NPI:1437108727
Name:KANAN, JOSEPH RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RICHARD
Last Name:KANAN
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 1:1940 N JACKSON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8254
Mailing Address - Country:US
Mailing Address - Phone:931-393-2401
Mailing Address - Fax:931-393-2402
Practice Address - Street 1:1940 N JACKSON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8254
Practice Address - Country:US
Practice Address - Phone:931-393-2401
Practice Address - Fax:931-393-2402
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515111Medicaid
TN1515111Medicaid