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General NPI Number Information
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NPI Number | 1992830095
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Entity Type | Organization
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Legal Business Name | PETER CHARLES SULACK D.C.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 10910 KINGSTON PIKE SUITE 101
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City | KNOXVILLE
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State | TN
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Zip | 37934-2931
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Country | US
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Telephone | 865-675-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 10910 KINGSTON PIKE SUITE 101
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City | KNOXVILLE
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State | TN
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Zip | 37934-2931
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Country | US
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Telephone | 865-675-2050
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOSH EASON
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Credential |
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Telephone | 865-675-2050
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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 |
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License Number State | TN
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