Southeast Tennessee Spine and Nerve Institute PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

SOUTHEAST TENNESSEE SPINE AND NERVE INSTITUTE PLLC

Practice address

1334 Mackey Branch Dr
Suite 104
Chattanooga, TN 37421-3471

Phone

(423) 296-2604

Fax

(423) 296-2607

NPI assigned

Apr 7, 2014

Last updated

Jun 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John WallNPI 1972694396

Title

Clinicdirector

Phone

(423) 296-2604

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Charles Blakely Wall, D.C.

  • Chiropractor
  • Chattanooga, TN
  • NPI 1972694396
  Authorized official Same address or phone

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1902225972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1334 MACKEY BRANCH DR",
            "address_2": "SUITE 104",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213471",
            "telephone_number": "423-296-2604",
            "fax_number": "423-296-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 MACKEY BRANCH DR",
            "address_2": "SUITE 104",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213471",
            "telephone_number": "423-296-2604",
            "fax_number": "423-296-2607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST TENNESSEE SPINE AND NERVE INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CLINICDIRECTOR",
        "authorized_official_telephone_number": "423-296-2604"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Community Service Agency
• Southeast Eye Specialists PLLC
• Southeast Surgical Solutions LLC
• Southeast Tennessee Health Clinic, LLC
• Southeast Tennessee Human Resource Agency/Hamilton County
• Southeast Transportation, LLC
• Southeastern Behavioral Health
• Southeastern Emergency Services of Memphis, P.C.
• Southeastern Endodontics
• Southeastern Orthotics & Prosthetics, Inc (Restorative Prosthetics & Orthotics)

• Physical Medicine & Rehabilitation Physician in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Physical Medicine & Rehabilitation Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.