Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301010557 | MI |
Y | 111NN0400X | Neurology | 0000003219 | TN |
NPI | 1588195085 |
---|---|
Provider Name | Trevor Dean Eason |
First Address | Cookeville, TN 38501-5806 |
Second Address | Cookeville, TN 38501-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2017 |
Last Update Date | 23/11/2019 |