Provider Demographics
NPI:1538260542
Name:BIRDWELL, JOSEPH CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:BIRDWELL
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 1:729 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3945
Mailing Address - Country:US
Mailing Address - Phone:865-982-0802
Mailing Address - Fax:865-984-2225
Practice Address - Street 1:729 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3945
Practice Address - Country:US
Practice Address - Phone:865-982-0802
Practice Address - Fax:865-984-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4482807OtherAETNA
TN4486027OtherAETNA
TN1B4146350OtherBCBST
TN4440144OtherUNITED HEALTHCARE
TN1B4146350OtherBCBST
TN4440144OtherUNITED HEALTHCARE
TN4482807OtherAETNA