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General NPI Number Information
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NPI Number | 1053583674
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Entity Type | Organization
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Legal Business Name | CENTER FOR PHYSICAL MEDICINE
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 1822 HUNTSVILLE HWY STE D
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3788
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Country | US
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Telephone | 931-438-0611
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Fax | 931-438-0622
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Provider Business Mailing Address
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Address Line | 1822 HUNTSVILLE HWY STE D
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3788
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Country | US
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Telephone | 931-438-0611
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Fax | 931-438-0622
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Authorized Official
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Title or Position | OWNER
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Name | JAMES ERIC DEATON
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Credential | D.C.
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Telephone | 931-438-0611
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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 | 1277
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License Number State | TN
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