Provider Demographics
NPI:1952346306
Name:GATLIN, JEREMY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:GATLIN
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 1:1800 SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2116
Mailing Address - Country:US
Mailing Address - Phone:731-288-9628
Mailing Address - Fax:731-288-9653
Practice Address - Street 1:1800 SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2116
Practice Address - Country:US
Practice Address - Phone:731-288-9628
Practice Address - Fax:731-288-9653
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7518458OtherAETNA
TN4054385OtherBLUE CROSS BLUE SHIELD
TN143272OtherUNISON
TN3972980Medicaid
TN4158534OtherCIGNA
TN3973008Medicare ID - Type UnspecifiedINDIVIDUAL
TN4158534OtherCIGNA
TN143272OtherUNISON