=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548470057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMBLEN COUNTY CHIROPRACTIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 02/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2244 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-4959
-----------------------------------------------------
Fax | 423-581-4954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2244 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-581-4959
-----------------------------------------------------
Fax | 423-581-4954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. RUSSELL ARVILLE JUSTUS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 423-581-4959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1855
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------