Provider Demographics
NPI:1801807698
Name:MESSIMER, SAMUEL F (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:F
Last Name:MESSIMER
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 1:501 W OAKLAND AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1666
Mailing Address - Country:US
Mailing Address - Phone:423-283-1300
Mailing Address - Fax:423-283-1306
Practice Address - Street 1:501 W OAKLAND AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1666
Practice Address - Country:US
Practice Address - Phone:423-283-1300
Practice Address - Fax:423-283-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN739111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3014511OtherBLUE CROSS BLUE SHEILD
TN3675650Medicare ID - Type Unspecified
TNU09821Medicare UPIN