Provider Demographics
NPI:1124204714
Name:ROY L. DEDMON
Entity type:Organization
Organization Name:ROY L. DEDMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DEDMON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:731-584-7926
Mailing Address - Street 1:115 HIGHWAY 641 S
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1639
Mailing Address - Country:US
Mailing Address - Phone:731-584-7926
Mailing Address - Fax:731-584-8192
Practice Address - Street 1:115 HIGHWAY 641 S
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1639
Practice Address - Country:US
Practice Address - Phone:731-584-7926
Practice Address - Fax:731-584-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673487Medicare PIN