Provider Demographics
NPI:1659306074
Name:EHLERT, BRUCE MARSHALL (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARSHALL
Last Name:EHLERT
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 1:1228 LIBERTY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-4305
Mailing Address - Country:US
Mailing Address - Phone:423-727-7713
Mailing Address - Fax:423-727-7713
Practice Address - Street 1:1228 LIBERTY CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-4305
Practice Address - Country:US
Practice Address - Phone:423-727-7713
Practice Address - Fax:423-727-7713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0018945OtherBCBS
TN1525015OtherUMWA
TN0018945OtherBCBS
TN1525015OtherUMWA