Detraves Neville Thicklin, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

210 Walmart Dr
Ste 100
Soddy Daisy, TN 37379-5022

Phone

(423) 332-9490

Fax

(423) 332-3817

NPI assigned

Dec 1, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1184167686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-362-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WALMART DR",
            "address_2": "STE 100",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373795022",
            "telephone_number": "423-332-9490",
            "fax_number": "423-332-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THICKLIN",
        "first_name": "DETRAVES",
        "middle_name": "NEVILLE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-01",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thomas C. Flanagan, D.D.S.
• Amaiya Thomas
• Brandon M Thomas, DC
• Allison Beth Thompson
• Thrive Chiropractic-Soddy Daisy

• Athletic Trainer in Soddy Daisy, TN
• Providers in Soddy Daisy, TN by specialty
• Athletic Trainer in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.