Provider Demographics
NPI:1669538229
Name:WEGENER, DONALD GILBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GILBERT
Last Name:WEGENER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:GILBERT
Other - Last Name:WEGENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7311 CLINTON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5224
Mailing Address - Country:US
Mailing Address - Phone:865-938-8700
Mailing Address - Fax:865-938-8706
Practice Address - Street 1:7311 CLINTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5224
Practice Address - Country:US
Practice Address - Phone:865-938-8700
Practice Address - Fax:865-938-8706
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 382111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673047Medicare ID - Type Unspecified