Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | TN |
NPI | 1376697029 |
---|---|
Provider Name | Dr. Douglas Tomanelli |
First Address | Hixson, TN 37343-5039 |
Second Address | Hixson, TN 37343-5039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |