Provider Demographics
NPI:1801975362
Name:FRITTS, DAVID SHANNON (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANNON
Last Name:FRITTS
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 1:1323 HWY 394
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-279-7850
Mailing Address - Fax:423-279-7851
Practice Address - Street 1:1323 HWY 394
Practice Address - Street 2:SUITE C
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-279-7850
Practice Address - Fax:423-279-7851
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971422Medicare ID - Type Unspecified