Healthcare Provider Details

I. General information

NPI: 1225867971
Provider Name (Legal Business Name): SPIRIT MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7446 SHALLOWFORD RD STE 108
CHATTANOOGA TN
37421-2352
US

IV. Provider business mailing address

7446 SHALLOWFORD RD STE 108
CHATTANOOGA TN
37421-2352
US

V. Phone/Fax

Practice location:
  • Phone: 423-855-7376
  • Fax:
Mailing address:
  • Phone: 423-855-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS CIRCOLONE
Title or Position: OWNER/PROVIDER
Credential: DIANM
Phone: 423-855-7376