Provider Demographics
NPI:1760667778
Name:GAMACHE CHIROPRACTIC
Entity Type:Organization
Organization Name:GAMACHE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-842-2828
Mailing Address - Street 1:8301 DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4202
Mailing Address - Country:US
Mailing Address - Phone:423-842-2828
Mailing Address - Fax:423-842-1688
Practice Address - Street 1:8301 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4202
Practice Address - Country:US
Practice Address - Phone:423-842-2828
Practice Address - Fax:423-842-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4157178OtherBLUE CROSS BLUE SHIELD
TN4157178OtherBLUE CROSS BLUE SHIELD