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General NPI Number Information
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NPI Number | 1871737908
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Entity Type | Organization
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Legal Business Name | SPECIALIZED CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 6519 NIGHTINGALE LN
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City | KNOXVILLE
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State | TN
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Zip | 37909-2753
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Country | US
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Telephone | 865-769-9190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51784
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City | KNOXVILLE
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State | TN
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Zip | 37950-1784
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Country | US
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Telephone | 865-769-9190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT GREGORY HAWK
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Credential | DC
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Telephone | 865-769-9190
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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 | DC1828
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License Number State | TN
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