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Individual

JOHN REDUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
302 MAIN ST, JACKSBORO, TN 37757-2935
(423) 566-4215
(423) 566-5155
Mailing address
302 MAIN ST, JACKSBORO, TN 37757-2935
(423) 566-4215
(423) 566-5155

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC000740
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100026514
PHP TENNCARE
TN
01
12786
CARITEN PREFERRED
TN
01
166746400
OHIO WORKER COMP
TN
01
350054860
RR MEDICARE
TN
05
3675808
TN
01
4026838
BLUE CROSS/TENNESSEE
TN
01
621871597
FEDERAL EMPLOYER ID NUMBE
TN
01
621871597 00
CRA MANAGED CARE
TN
Enumeration date
07/08/2005
Last updated
06/12/2012
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