MEDICARE: HOLISTIC CHIROPRACTIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1477581023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	603 HIGHWAY 321 N
Second Line	:	BLDG 3 STE 201
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 HIGHWAY 321 N
Second Line	:	BLDG 3 STE 201
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6575
Country	:	US
Telephone Number	:	865-988-9815
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREA SHAKARIAN
Credential	:	D.C.
Telephone Number	:	865-988-9815

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	08/22/2020

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