Provider Demographics
NPI:1346361607
Name:TOLLEFSON, DARREN R (DC)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:R
Last Name:TOLLEFSON
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 1:555 E MEETING ST
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-5003
Mailing Address - Country:US
Mailing Address - Phone:865-397-3388
Mailing Address - Fax:865-397-3389
Practice Address - Street 1:555 E MEETING ST
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-5003
Practice Address - Country:US
Practice Address - Phone:865-397-3388
Practice Address - Fax:865-397-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971495Medicare ID - Type UnspecifiedCHIROPRACTIC