Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2601 | TN |
N | 111NN1001X | Nutrition | 2601 | TN |
NPI | 1194063347 |
---|---|
Provider Name | Debra Wiertel |
First Address | Chattanooga, TN 37421-7127 |
Second Address | Hixson, TN 37343-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2013 |
Last Update Date | 08/03/2013 |