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General NPI Number Information
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NPI Number | 1548619497
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Entity Type | Organization
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Legal Business Name | DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 556 TRINITY CREEK CV
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City | CORDOVA
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State | TN
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Zip | 38018-2279
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Country | US
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Telephone | 901-573-2526
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Fax | 901-614-2523
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Provider Business Mailing Address
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Address Line | 9740 ROYAL CHARTRES SQ N #201
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City | CORDOVA
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State | TN
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Zip | 38018-4423
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Country | US
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Telephone | 901-573-2526
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | DR. TYREL DETWEILER
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Credential | D.C.
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Telephone | 901-573-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2894
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License Number State | TN
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