Provider Demographics
NPI:1316304629
Name:DEEP RIVER WELLNESS CENTER
Entity type:Organization
Organization Name:DEEP RIVER WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LACUPUNCTURIST, CH
Authorized Official - Phone:865-687-6452
Mailing Address - Street 1:314 KNOX RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2316
Mailing Address - Country:US
Mailing Address - Phone:865-687-6452
Mailing Address - Fax:
Practice Address - Street 1:314 KNOX RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2316
Practice Address - Country:US
Practice Address - Phone:865-687-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN010261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty