John Charles Blakely Wall, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR005485 Issued in GA

Practice address

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

Phone

(423) 296-2604

Fax

(423) 296-2607

NPI assigned

Sep 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tennessee Center for Regenerative Medicine PC

  • Adult Medicine Physician
  • Chattanooga, TN
  • NPI 1730791963
  NPD

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1972694396",
    "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": {
        "last_name": "WALL",
        "first_name": "JOHN",
        "middle_name": "CHARLES BLAKELY",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR005485",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "DC0000001504",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany K Walker, DDS
• Vickie A. Walker, CRNA
• Wendy J Walker, CRNA
• Willie Bo Walker, LCSW
• Ann M Wall, RPH
• Madison Nicole Wall
• Sarah Eileen Wall
• David Joseph Wallace, M.D.
• Elizabeth J Wallace, CCC-SLP
• Kaitlyn Wallace, LPC-MHSP

• Chiropractor in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.