Provider Demographics
NPI:1811332349
Name:BLACKBURN, AUTUMN TENAE (DC)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:TENAE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14811 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1820
Mailing Address - Country:US
Mailing Address - Phone:615-758-5650
Mailing Address - Fax:615-758-5651
Practice Address - Street 1:14811 LEBANON RD
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-1820
Practice Address - Country:US
Practice Address - Phone:615-758-5650
Practice Address - Fax:615-758-5651
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor