Provider Demographics
NPI:1598997124
Name:QUEEN, ALAN CHARLES (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:CHARLES
Last Name:QUEEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1238
Mailing Address - Country:US
Mailing Address - Phone:423-388-8940
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1238
Practice Address - Country:US
Practice Address - Phone:423-388-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7561172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist