Healthcare Provider Details

I. General information

NPI: 1285792929
Provider Name (Legal Business Name): MARCO E. CASTANEDA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2009
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 TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2115
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number2115
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2115
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: