Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC0000001115 | TN |
NPI | 1184747271 |
---|---|
Provider Name | Thomas Koontz |
First Address | Germantown, TN 38183-1408 |
Second Address | Germantown, TN 38138-3949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3084009 | BLUECROSS BLUESHIELD (01) | TN |