Healthcare Provider Details

I. General information

NPI: 1437180304
Provider Name (Legal Business Name): AMANDA FAYE JERVISS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11642 CHAPMAN HWY
SEYMOUR TN
37865
US

IV. Provider business mailing address

11642 CHAPMAN HWY
SEYMOUR TN
37865
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-6500
  • Fax: 865-573-6555
Mailing address:
  • Phone: 865-573-6500
  • Fax: 865-573-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0000002076
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: