=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538283270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANUEL M MENDEZ D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 03/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 MERCHANTS DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37912-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-687-7246
-----------------------------------------------------
Fax | 865-688-7965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 MERCHANTS DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37912-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-687-7246
-----------------------------------------------------
Fax | 865-688-7965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC0000000681
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------