Provider Demographics
NPI:1659637049
Name:MARGATA INCORPATION
Entity type:Organization
Organization Name:MARGATA INCORPATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-687-7246
Mailing Address - Street 1:710 MERCHANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912
Mailing Address - Country:US
Mailing Address - Phone:865-687-7246
Mailing Address - Fax:865-688-7965
Practice Address - Street 1:710 MERCHANT DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912
Practice Address - Country:US
Practice Address - Phone:865-687-7246
Practice Address - Fax:865-688-7965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENDEZ CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3676181Medicare UPIN