Provider Demographics
NPI:1063432177
Name:MCSTAY, JOHN B (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:MCSTAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 RUTLEDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2252
Mailing Address - Country:US
Mailing Address - Phone:865-525-2121
Mailing Address - Fax:865-525-7892
Practice Address - Street 1:5917 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2252
Practice Address - Country:US
Practice Address - Phone:865-525-2121
Practice Address - Fax:865-525-7892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00001050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0183210OtherBCBS OF TN
TN3676925Medicaid
TN44920Medicare UPIN
TN3676925Medicare ID - Type Unspecified