Provider Demographics
NPI:1992179956
Name:BRIDGES CHIROPRACTIC
Entity Type:Organization
Organization Name:BRIDGES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-357-2225
Mailing Address - Street 1:117 HUXLEY RD STE B1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3180
Mailing Address - Country:US
Mailing Address - Phone:865-357-2225
Mailing Address - Fax:865-357-6325
Practice Address - Street 1:117 HUXLEY RD STE B1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3180
Practice Address - Country:US
Practice Address - Phone:865-357-2225
Practice Address - Fax:865-357-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU70518Medicare UPIN