MEDICARE: DR. DALE WAYNE BLACKWELDER 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	DC001075	TN

General Provider Information

NPI Number	:	1932106820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE WAYNE BLACKWELDER D.C.

Provider Business Mailing Address
First Line	:	P O BOX 785
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372
Country	:	US
Telephone Number	:	731-925-2225
Fax Number	:	731-925-2226

Provider Business Practice Location Address
First Line	:	635 WATER ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-2442
Country	:	US
Telephone Number	:	731-925-2225
Fax Number	:	731-925-2226

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/28/2016

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