Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1311 | TN |
NPI | 1821195454 |
---|---|
Provider Name | Dr. Stephen Edward Wheeler |
First Address | Elizabethton, TN 37643-2312 |
Second Address | Elizabethton, TN 37643-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3046166 | BCBS # (01) | TN |
U62188 | (02) | TN |