Provider Demographics
NPI:1609389923
Name:JAMES BERTRAM SOLOMON
Entity Type:Organization
Organization Name:JAMES BERTRAM SOLOMON
Other - Org Name:KNOXVILLE SPINE AND SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BERTRAM
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:865-337-5574
Mailing Address - Street 1:8029 RAY MEARS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2710
Mailing Address - Country:US
Mailing Address - Phone:865-337-5574
Mailing Address - Fax:865-313-2461
Practice Address - Street 1:8029 RAY MEARS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2710
Practice Address - Country:US
Practice Address - Phone:865-337-5574
Practice Address - Fax:865-313-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1800111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty