Individual
DR. RANDY D. MODGLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
306 SUNSET DR, STE 100, JOHNSON CITY, TN 37604-2492
(423) 926-8304
(423) 926-5976
Mailing address
306 SUNSET DR STE 100, JOHNSON CITY, TN 37604-2492
(423) 926-8304
(423) 926-5976
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1352
TN
111N00000X
Chiropractor
Primary
DC0000001352
TN
111NN0400X
Neurology Chiropractor
DC0000001352
TN
111NN1001X
Nutrition Chiropractor
DC0000001352
TN
111NR0200X
Radiology Chiropractor
DC0000001352
TN
111NR0400X
Rehabilitation Chiropractor
DC0000001352
TN
111NS0005X
Sports Physician Chiropractor
DC0000001352T
TN
111NX0800X
Orthopedic Chiropractor
DC0000001352
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3074458
BLUE CROSS BLUE SHIELD
TN
01
—
350052904
RAILROAD MEDICARE
—
Enumeration date
01/09/2007
Last updated
08/24/2020
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