Provider Demographics
NPI:1699838037
Name:FILLMORE, BRIAN J (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:FILLMORE
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 1:1364 INTERSTATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6187
Mailing Address - Country:US
Mailing Address - Phone:931-456-8880
Mailing Address - Fax:931-456-8883
Practice Address - Street 1:1260 GALLAHER RD STE A-C
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4139
Practice Address - Country:US
Practice Address - Phone:865-248-8167
Practice Address - Fax:865-248-8125
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3009111NN1001X
TN1440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5233596OtherAETNA
OH663526OtherACN UNITED HEALTH CARE
TNQ085835Medicaid
OH000000393235OtherANTHEM BC BS
U70784Medicare UPIN