Provider Demographics
NPI:1952472359
Name:PANNELL, ROBERT WINSTON (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WINSTON
Last Name:PANNELL
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 1:613 A WATAUGA STREET
Mailing Address - Street 2:ATTENTION DR ROBERT W PANNELL
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-246-1963
Mailing Address - Fax:423-246-6452
Practice Address - Street 1:613 A WATAUGA STREET
Practice Address - Street 2:DR ROBERT W PANNELL
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-246-1963
Practice Address - Fax:423-246-6452
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000340111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0020645OtherBLUE CROSS BLUE SHIELD
T74538Medicare UPIN
3676512Medicare ID - Type Unspecified