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General NPI Number Information
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NPI Number | 1033300173
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Entity Type | Organization
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Legal Business Name | JEREMY WAYNE GATLIN
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 624 US HIGHWAY 51 BYP W
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City | DYERSBURG
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State | TN
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Zip | 38024-1949
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Country | US
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Telephone | 731-288-9628
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Fax | 731-288-9653
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Provider Business Mailing Address
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Address Line | 1800 SAINT JOHN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2116
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Country | US
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Telephone | 731-288-9628
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Fax | 731-288-9653
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JILL CHRISTINE GATLIN
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Credential | D.C.
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Telephone | 731-288-9628
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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 | 1900
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License Number State | TN
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