Healthcare Provider Details

I. General information

NPI: 1801807698
Provider Name (Legal Business Name): SAMUEL F MESSIMER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W OAKLAND AVE SUITE #3
JOHNSON CITY TN
37604-1666
US

IV. Provider business mailing address

501 W OAKLAND AVE SUITE #3
JOHNSON CITY TN
37604-1666
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-1300
  • Fax: 423-283-1306
Mailing address:
  • Phone: 423-283-1300
  • Fax: 423-283-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number739
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: