Provider Demographics
NPI:1982737953
Name:BILLINGSLEY, JOHN BERNARD JR (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERNARD
Last Name:BILLINGSLEY
Suffix:JR
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3520
Mailing Address - Country:US
Mailing Address - Phone:931-359-3468
Mailing Address - Fax:931-270-0952
Practice Address - Street 1:1024 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3520
Practice Address - Country:US
Practice Address - Phone:931-359-3468
Practice Address - Fax:931-270-0952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0018631OtherBLUE CROSS BLUE SHIELD
TN3677520Medicare ID - Type Unspecified
TN0018631OtherBLUE CROSS BLUE SHIELD