Provider Demographics
NPI:1669553293
Name:PRICE, JERRY ALLEN II (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLEN
Last Name:PRICE
Suffix:II
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:PO BOX 5958
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-0958
Mailing Address - Country:US
Mailing Address - Phone:423-239-4311
Mailing Address - Fax:423-239-3107
Practice Address - Street 1:3901 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2025
Practice Address - Country:US
Practice Address - Phone:423-239-4311
Practice Address - Fax:423-239-3107
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5949771OtherAETNA
TN3114118OtherBLUE CROSS BLUE SHIELD
TNU73436Medicare UPIN
TN3970065Medicare ID - Type Unspecified