Provider Demographics
NPI:1255602819
Name:HIPPARD, TRENT MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:MICHAEL
Last Name:HIPPARD
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 1:120 CAPITAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3475
Mailing Address - Country:US
Mailing Address - Phone:815-298-3667
Mailing Address - Fax:
Practice Address - Street 1:120 CAPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3475
Practice Address - Country:US
Practice Address - Phone:865-474-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011992111N00000X
TN0000003312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor