Provider Demographics
NPI:1780627828
Name:DEDMON, ROY L II (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:L
Last Name:DEDMON
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 1:115 HIGHWAY 641 S
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1636
Mailing Address - Country:US
Mailing Address - Phone:731-584-7926
Mailing Address - Fax:731-584-8192
Practice Address - Street 1:115 HIGHWAY 641 S
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1636
Practice Address - Country:US
Practice Address - Phone:731-584-7926
Practice Address - Fax:731-584-8192
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU23771Medicare UPIN