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General NPI Number Information
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NPI Number | 1871618363
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Entity Type | Individual
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Provider Name | MICHAEL DAVID SULACK D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 713 E EMORY ROAD
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City | KNOXVILLE
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State | TN
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Zip | 37938-2856
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Country | US
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Telephone | 865-938-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 12920 PEACH VIEW DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-9342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1970
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License Number State | TN
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