MEDICARE: BEARDEN HEALTHCARE ASSOCIATES INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC0000000705	TN
2	111N00000X	Chiropractor	DC0000000766	TN
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD53866	TN
4	207Q00000X	Family Medicine Physician	MD0000016119	TN
5	207L00000X	Anesthesiology Physician	MD53866	TN
6	332B00000X	Durable Medical Equipment & Medical Supplies		TN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7379550001	OTHER	TN	DURABLE MEDICAL EQUIPMENT

NPI Number	:	1144253469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEARDEN HEALTHCARE ASSOCIATES INC

Provider Business Mailing Address
First Line	:	10321 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3224
Country	:	US
Telephone Number	:	865-584-3565
Fax Number	:	865-584-2956

Provider Business Practice Location Address
First Line	:	10321 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3224
Country	:	US
Telephone Number	:	865-584-3565
Fax Number	:	865-584-2956

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN/OWNER
Name	:	GLENN D JOHNSON
Credential	:	DC
Telephone Number	:	865-584-3565

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	06/05/2017

10321 KINGSTON PIKE STE 114
KNOXVILLE, TN
37922-3224

Practice Phone: 865-333-6554
Practice Fax: