Provider Demographics
NPI:1760403372
Name:GAWTHROP, PHILLIP CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CHARLES
Last Name:GAWTHROP
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 1:6978 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3834
Mailing Address - Country:US
Mailing Address - Phone:423-899-0808
Mailing Address - Fax:423-499-5149
Practice Address - Street 1:6978 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3834
Practice Address - Country:US
Practice Address - Phone:423-899-0808
Practice Address - Fax:423-499-5149
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0075288OtherBLUE CROSS BLUE SHIELD
TN41554347OtherBLUECROSS BLUESHIELD
TN3674367Medicare PIN
TN41554347OtherBLUECROSS BLUESHIELD