Provider Demographics
NPI:1194931840
Name:ALLISON, DWAINE M (DC)
Entity type:Individual
Prefix:DR
First Name:DWAINE
Middle Name:M
Last Name:ALLISON
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 1:128 HOLIDAY CT STE 107
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-3092
Mailing Address - Country:US
Mailing Address - Phone:615-790-6363
Mailing Address - Fax:615-790-2754
Practice Address - Street 1:128 HOLIDAY CT STE 107
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3092
Practice Address - Country:US
Practice Address - Phone:615-790-6363
Practice Address - Fax:615-790-2754
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621789984OtherTAX IDENTIFICATION NUMBER
TN3040157Medicaid
TN3040157Medicaid
TN3678547Medicare PIN