Healthcare Provider Details

I. General information

NPI: 1932106820
Provider Name (Legal Business Name): DALE WAYNE BLACKWELDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 WATER ST
SAVANNAH TN
38372-2442
US

IV. Provider business mailing address

P O BOX 785
SAVANNAH TN
38372
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-2225
  • Fax: 731-925-2226
Mailing address:
  • Phone: 731-925-2225
  • Fax: 731-925-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC001075
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: