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General NPI Number Information
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NPI Number | 1003209180
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Entity Type | Organization
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Legal Business Name | SPORT AND WELLNESS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 10426 JACKSON OAKS WAY STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37922-0711
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Country | US
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Telephone | 865-219-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 10426 JACKSON OAKS WAY STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37922-0711
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Country | US
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Telephone | 865-219-3570
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Fax |
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Authorized Official
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Title or Position | OWNER / CHIROPRACTIC PHYSICIAN
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Name | DR. JOHN ROBERT DANDELSKI
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Credential | D.C.
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Telephone | 865-219-3570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 02667
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License Number State | TN
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