Healthcare Provider Details

I. General information

NPI: 1316114010
Provider Name (Legal Business Name): MAJOR LAWRENCE TALLENT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 BRAINERD RD
CHATTANOOGA TN
37411-5310
US

IV. Provider business mailing address

PO BOX 213
VONORE TN
37885-0213
US

V. Phone/Fax

Practice location:
  • Phone: 423-510-6900
  • Fax:
Mailing address:
  • Phone: 404-553-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2497
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5021
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number5021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: