Healthcare Provider Details

I. General information

NPI: 1548470057
Provider Name (Legal Business Name): HAMBLEN COUNTY CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814
US

IV. Provider business mailing address

2244 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-4959
  • Fax: 423-581-4954
Mailing address:
  • Phone: 423-581-4959
  • Fax: 423-581-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1855
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL ARVILLE JUSTUS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 423-581-4959