Provider Demographics
NPI:1710958129
Name:FIELDS, GARY LEE (BS DC LMT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:BS DC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354
Mailing Address - Country:US
Mailing Address - Phone:423-442-1244
Mailing Address - Fax:
Practice Address - Street 1:4900 NEW HWY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354
Practice Address - Country:US
Practice Address - Phone:423-442-1244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000814111N00000X
TNMT0000004004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4066684OtherBLUE CROSS
P00115609OtherRR MEDICARE
TN4066684OtherBLUE CROSS
U31020Medicare UPIN