MEDICARE: DR. MANUEL M MENDEZ D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC0000000681	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0112478	OTHER	TN	BC BS

General Provider Information

NPI Number	:	1538283270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL M MENDEZ D.C.

Provider Business Mailing Address
First Line	:	710 MERCHANTS DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3806
Country	:	US
Telephone Number	:	865-687-7246
Fax Number	:	865-688-7965

Provider Business Practice Location Address
First Line	:	710 MERCHANTS DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3806
Country	:	US
Telephone Number	:	865-687-7246
Fax Number	:	865-688-7965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/30/2012

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