Provider Demographics
NPI:1922696780
Name:DOUGLAS, PRESTON S (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:S
Last Name:DOUGLAS
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 1:4012 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2028
Mailing Address - Country:US
Mailing Address - Phone:423-239-9122
Mailing Address - Fax:423-239-7991
Practice Address - Street 1:4012 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2028
Practice Address - Country:US
Practice Address - Phone:423-239-9122
Practice Address - Fax:423-239-7991
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20000407882255A2300X
VA0104-557713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer