Healthcare Provider Details

I. General information

NPI: 1720256357
Provider Name (Legal Business Name): GENESIS CHIROPRACTIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7786 EMORY CHASE LN
KNOXVILLE TN
37918-6147
US

IV. Provider business mailing address

7786 EMORY CHASE LN
KNOXVILLE TN
37918-6147
US

V. Phone/Fax

Practice location:
  • Phone: 865-454-0313
  • Fax:
Mailing address:
  • Phone: 865-454-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC0000002115
License Number StateTN

VIII. Authorized Official

Name: DR. MARCO E CASTANEDA
Title or Position: MEMBER
Credential: DC
Phone: 865-454-0313