Provider Demographics
NPI:1619012507
Name:WOODROW W GWINN JR
Entity Type:Organization
Organization Name:WOODROW W GWINN JR
Other - Org Name:KNOXVILLE 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 JR
Authorized Official - Suffix:
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 1:259 N PETERS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4923
Practice Address - Country:US
Practice Address - Phone:865-690-6898
Practice Address - Fax:865-690-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732364Medicaid