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General NPI Number Information
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NPI Number | 1659637049
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Entity Type | Organization
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Legal Business Name | MARGATA INCORPATION
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 710 MERCHANT DRIVE
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City | KNOXVILLE
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State | TN
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Zip | 37912
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Country | US
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Telephone | 865-687-7246
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Fax | 865-688-7965
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Provider Business Mailing Address
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Address Line | 710 MERCHANT DRIVE
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City | KNOXVILLE
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State | TN
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Zip | 37912
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Country | US
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Telephone | 865-687-7246
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Fax | 865-688-7965
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MANUEL MENDEZ
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Credential | D.C.
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Telephone | 865-687-7246
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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 | 681
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License Number State | TN
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