MEDICARE: CHAVIS MCDERMOTT 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	4032	TN

General Provider Information

NPI Number	:	1922967603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAVIS MCDERMOTT DC

Provider Business Mailing Address
First Line	:	354 OLD GALLATIN RD
Second Line	:
City	:	SCOTTSVILLE
State	:	KY
Zip	:	42164-8666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 W MARKET ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-2510
Country	:	US
Telephone Number	:	615-745-4044
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ CHAVIS MCDERMOTT DC” Practice Location

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