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General NPI Number Information
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NPI Number | 1124211917
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Entity Type | Organization
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Legal Business Name | TRINITY CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 2724 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-2557
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Country | US
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Telephone | 865-379-0505
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Fax | 865-983-8181
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Provider Business Mailing Address
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Address Line | 2724 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-2557
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Country | US
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Telephone | 865-379-0505
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Fax | 865-983-8181
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EVAN WILLIAM BUTCHER
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Credential | D.C.
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Telephone | 865-379-0505
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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 | DC0000001995
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License Number State | TN
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