Healthcare Provider Details

I. General information

NPI: 1699838037
Provider Name (Legal Business Name): BRIAN J. FILLMORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 GALLAHER RD STE A-C
KINGSTON TN
37763-4139
US

IV. Provider business mailing address

1364 INTERSTATE DR STE 101
CROSSVILLE TN
38555-6187
US

V. Phone/Fax

Practice location:
  • Phone: 865-248-8167
  • Fax: 865-248-8125
Mailing address:
  • Phone: 931-456-8880
  • Fax: 931-456-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3009
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1440
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: