Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC0000001989 | TN |
NPI | 1003833963 |
---|---|
Provider Name | Dr. Daniel Bradford Mcmahan |
First Address | Maryville, TN 37801-3104 |
Second Address | Maryville, TN 37801-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V03155 | (02) |