MEDICARE: JEFFREY RYAN PRUITT DC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3511	TN

General Provider Information

NPI Number	:	1811654932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY RYAN PRUITT DC

Provider Business Mailing Address
First Line	:	7347 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5714
Country	:	US
Telephone Number	:	585-507-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	7347 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5714
Country	:	US
Telephone Number	:	585-507-8075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	11/23/2021

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Directions to “ JEFFREY RYAN PRUITT DC” Practice Location

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