Healthcare Provider Details

I. General information

NPI: 1982669792
Provider Name (Legal Business Name): DANIEL JOSEPH JUREK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W. DUMPLIN VALLEY RD.
DANDRIDGE TN
37725
US

IV. Provider business mailing address

1148 HAROLD PATTERSON RD
DANDRIDGE TN
37725-6018
US

V. Phone/Fax

Practice location:
  • Phone: 865-397-0780
  • Fax: 865-397-4121
Mailing address:
  • Phone: 865-397-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number187
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: