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General NPI Number Information
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NPI Number | 1821292442
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Entity Type | Organization
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Legal Business Name | BIRDWELL CHIROPRACTIC CLINIC, PLLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 729 W LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37801-3945
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Country | US
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Telephone | 865-982-0802
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Fax | 865-984-2225
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Provider Business Mailing Address
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Address Line | 729 W LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37801-3945
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Country | US
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Telephone | 865-982-0802
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Fax | 865-984-2225
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | DR. JOSEPH C. BIRDWELL
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Credential | D.C.
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Telephone | 865-982-0802
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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 | DC0000000136
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License Number State | TN
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