Provider Demographics
NPI:1497753982
Name:REDUS, JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REDUS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:CLEVE
Other - Middle Name:
Other - Last Name:REDUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2935
Mailing Address - Country:US
Mailing Address - Phone:423-566-4215
Mailing Address - Fax:423-566-5155
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2935
Practice Address - Country:US
Practice Address - Phone:423-566-4215
Practice Address - Fax:423-566-5155
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC000740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4026838OtherBLUE CROSS/TENNESSEE
TN621871597 00OtherCRA MANAGED CARE
TN100026514OtherPHP TENNCARE
TN350054860OtherRR MEDICARE
TN166746400OtherOHIO WORKER COMP
TN621871597OtherFEDERAL EMPLOYER ID NUMBE
TN12786OtherCARITEN PREFERRED
TN3675808Medicaid
TNU16355Medicare UPIN
TN12786OtherCARITEN PREFERRED