Provider Demographics
NPI:1548833346
Name:EAST TENNESSEE WELLNESS PARTNERS PLLC
Entity type:Organization
Organization Name:EAST TENNESSEE WELLNESS PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-936-1102
Mailing Address - Street 1:1450 ST THOMAS WAY
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1847
Mailing Address - Country:US
Mailing Address - Phone:865-936-1102
Mailing Address - Fax:
Practice Address - Street 1:1450 ST THOMAS WAY
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1847
Practice Address - Country:US
Practice Address - Phone:865-936-1102
Practice Address - Fax:865-983-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1316237753OtherNPI
TN1790731172OtherNPI
1316114010OtherNPI