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General NPI Number Information
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NPI Number | 1154747418
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Entity Type | Organization
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Legal Business Name | GENESIS CENTER FOR WELLNESS
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 2244 BOONES CREEK RD
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City | JOHNSON CITY
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State | TN
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Zip | 37615-4432
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Country | US
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Telephone | 423-788-3294
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Fax | 423-788-3295
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Provider Business Mailing Address
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Address Line | 2244 BOONES CREEK RD
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City | JOHNSON CITY
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State | TN
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Zip | 37615-4432
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Country | US
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Telephone | 423-788-3294
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Fax | 423-788-3295
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | JOSEPH JOSHUA GILMER
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Credential | DC
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Telephone | 423-788-3294
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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 | DC0000002432
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA1941
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License Number State | TN
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