Provider Demographics
NPI:1831335595
Name:ATHENS CLINIC OF CHIROPRACTIC INC.
Entity type:Organization
Organization Name:ATHENS CLINIC OF CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-746-4544
Mailing Address - Street 1:620 CONGRESS PKWY N
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-1618
Mailing Address - Country:US
Mailing Address - Phone:423-746-4544
Mailing Address - Fax:423-746-4545
Practice Address - Street 1:620 CONGRESS PKWY N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1618
Practice Address - Country:US
Practice Address - Phone:423-746-4544
Practice Address - Fax:423-746-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3856921Medicare PIN