Healthcare Provider Details

I. General information

NPI: 1497753982
Provider Name (Legal Business Name): JOHN REDUS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLEVE REDUS D.C.

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MAIN ST
JACKSBORO TN
37757-2935
US

IV. Provider business mailing address

302 MAIN ST
JACKSBORO TN
37757-2935
US

V. Phone/Fax

Practice location:
  • Phone: 423-566-4215
  • Fax: 423-566-5155
Mailing address:
  • Phone: 423-566-4215
  • Fax: 423-566-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC000740
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: