Provider Demographics
NPI:1295890549
Name:SETZER, SANDRA SUE (DC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:SETZER
Suffix:
Gender:F
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:PO BOX 11277
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1277
Mailing Address - Country:US
Mailing Address - Phone:865-588-5734
Mailing Address - Fax:865-588-5738
Practice Address - Street 1:6911 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5703
Practice Address - Country:US
Practice Address - Phone:865-588-5734
Practice Address - Fax:865-588-5738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9401272OtherPHCS
TN11498274OtherCAQH
TN2953790OtherCIGNA
TN2953790OtherCIGNA
TN3973778Medicare ID - Type Unspecified