Provider Demographics
NPI:1659339158
Name:BRAGG, TERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:BRAGG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LEEPER PKWY
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6151
Mailing Address - Country:US
Mailing Address - Phone:865-986-8600
Mailing Address - Fax:865-986-0961
Practice Address - Street 1:615 LEEPER PKWY
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6151
Practice Address - Country:US
Practice Address - Phone:865-986-8600
Practice Address - Fax:865-986-0961
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000477OtherBLUE CROSS BLUE SHIELD
TN3671572Medicare ID - Type Unspecified