Provider Demographics
NPI:1508901471
Name:WOODROW W. GWINN JR.
Entity Type:Organization
Organization Name:WOODROW W. GWINN JR.
Other - Org Name:MARYVILLE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:W
Authorized Official - Last Name:GWINN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:865-977-0916
Mailing Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5283
Mailing Address - Country:US
Mailing Address - Phone:865-977-0916
Mailing Address - Fax:865-984-3519
Practice Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5283
Practice Address - Country:US
Practice Address - Phone:865-977-0916
Practice Address - Fax:865-984-3519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723208Medicaid