Healthcare Provider Details

I. General information

NPI: 1821195454
Provider Name (Legal Business Name): STEPHEN EDWARD WHEELER BS., DC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 BROAD ST
ELIZABETHTON TN
37643-2312
US

IV. Provider business mailing address

835 BROAD ST
ELIZABETHTON TN
37643-2312
US

V. Phone/Fax

Practice location:
  • Phone: 423-542-4103
  • Fax: 423-542-4103
Mailing address:
  • Phone: 423-542-4103
  • Fax: 423-542-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1311
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: