Provider Demographics
NPI:1023101664
Name:MAUCERE, RAYMOND ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANDREW
Last Name:MAUCERE
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 1:3600 HIXSON PIKE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3561
Mailing Address - Country:US
Mailing Address - Phone:423-875-6555
Mailing Address - Fax:423-875-6567
Practice Address - Street 1:3600 HIXSON PIKE
Practice Address - Street 2:SUITE 114
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3561
Practice Address - Country:US
Practice Address - Phone:423-875-6555
Practice Address - Fax:423-875-6567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN191482OtherBCBS
TN3677401Medicaid
TN3677401Medicaid
TN3677401Medicare PIN