Healthcare Provider Details

I. General information

NPI: 1639358690
Provider Name (Legal Business Name): BRENTWOOD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 OLD HICKORY BLVD SUITE 200
BRENTWOOD TN
37027-4512
US

IV. Provider business mailing address

785 OLD HICKORY BOULEVARD SUITE 200
BRENTWOOD TN
37024-2026
US

V. Phone/Fax

Practice location:
  • Phone: 615-373-0276
  • Fax: 615-373-0879
Mailing address:
  • Phone: 615-373-0276
  • Fax: 615-373-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number111NS0005X
License Number StateTN

VIII. Authorized Official

Name: DR. DONALD CARL HUDSON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 615-373-0276