Healthcare Provider Details

I. General information

NPI: 1073755575
Provider Name (Legal Business Name): TENNESSEE VALLEY CLINIC OF CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 1ST AVE
DAYTON TN
37321-1290
US

IV. Provider business mailing address

PO BOX 996
DAYTON TN
37321-0996
US

V. Phone/Fax

Practice location:
  • Phone: 423-775-6688
  • Fax: 423-775-8777
Mailing address:
  • Phone: 423-775-6688
  • Fax: 423-775-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberDC0000002218
License Number StateTN

VIII. Authorized Official

Name: DR. KEVIN JOEL MOORE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 423-775-6688