Provider Demographics
NPI:1477826014
Name:PRINCETON HEALTHCARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:PRINCETON HEALTHCARE ASSOCIATES, PC
Other - Org Name:JOHNSON CITY CHIROPRACTIC CLINIC, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-283-4055
Mailing Address - Street 1:206 PRINCETON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2058
Mailing Address - Country:US
Mailing Address - Phone:423-283-4905
Mailing Address - Fax:423-283-4200
Practice Address - Street 1:206 PRINCETON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2058
Practice Address - Country:US
Practice Address - Phone:423-283-4905
Practice Address - Fax:423-283-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0083272OtherBCBS
TN3674651Medicare UPIN