Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2497 | TN |
N | 111NI0013X | Independent Medical Examiner | 5021 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | 5021 | GA |
NPI | 1316114010 |
---|---|
Provider Name | Dr. Major Lawrence Tallent |
First Address | Vonore, TN 37885-0213 |
Second Address | Chattanooga, TN 37411-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 05/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352CXT | (02) | GA |