Provider Demographics
NPI:1861591240
Name:RUMBOLT, SHAWN L (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:L
Last Name:RUMBOLT
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 1:2712 E MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-5246
Mailing Address - Country:US
Mailing Address - Phone:865-522-8348
Mailing Address - Fax:865-522-8348
Practice Address - Street 1:2712 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-5246
Practice Address - Country:US
Practice Address - Phone:865-522-8348
Practice Address - Fax:865-522-8348
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT81688OtherUPIN
TN00954573OtherTENNCARE
TN3674789Medicare PIN