Provider Demographics
NPI:1467662809
Name:KINGSPORT FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:KINGSPORT FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-246-1963
Mailing Address - Street 1:613 WATAUGA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4429
Mailing Address - Country:US
Mailing Address - Phone:423-246-1963
Mailing Address - Fax:
Practice Address - Street 1:613 WATAUGA ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4429
Practice Address - Country:US
Practice Address - Phone:423-246-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID