Healthcare Provider Details

I. General information

NPI: 1417366717
Provider Name (Legal Business Name): DEBRA C. WIERTEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 NORTHPOINT BLVD 109
HIXSON TN
37343
US

IV. Provider business mailing address

1963 NORTHPOINT BLVD 109
HIXSON TN
37343
US

V. Phone/Fax

Practice location:
  • Phone: 423-355-5126
  • Fax: 423-355-5235
Mailing address:
  • Phone: 423-355-5126
  • Fax: 423-355-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBRA CHRISTINA WIERTEL
Title or Position: CHIROPRACTIC
Credential: DC
Phone: 423-355-5126