Healthcare Provider Details

I. General information

NPI: 1316133176
Provider Name (Legal Business Name): SULACK CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 E EMORY RD
KNOXVILLE TN
37938-4614
US

IV. Provider business mailing address

713 E EMORY RD
KNOXVILLE TN
37938-4614
US

V. Phone/Fax

Practice location:
  • Phone: 865-938-1070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1970
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL SULACK
Title or Position: PRESIDENT
Credential:
Phone: 865-938-1070