Provider Demographics
NPI:1871737908
Name:SPECIALIZED CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SPECIALIZED CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-769-9190
Mailing Address - Street 1:PO BOX 51784
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1784
Mailing Address - Country:US
Mailing Address - Phone:865-769-9190
Mailing Address - Fax:
Practice Address - Street 1:6519 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2753
Practice Address - Country:US
Practice Address - Phone:865-769-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000009266391OtherCPID
TN000810443888OtherPHCS
TN10834598OtherGREAT WEST
TN10834595OtherCAQH
TN4025407OtherBCBS
TN10834598OtherGREAT WEST