Healthcare Provider Details

I. General information

NPI: 1720407570
Provider Name (Legal Business Name): RIVERSIDE SPINE & PHYSICAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W DUNBAR CAVE RD
CLARKSVILLE TN
37040-6037
US

IV. Provider business mailing address

121 W DUNBAR CAVE RD
CLARKSVILLE TN
37040-6037
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-9420
  • Fax: 931-542-9422
Mailing address:
  • Phone: 931-542-9420
  • Fax: 931-542-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD28572
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYNTHIA J CHESTER
Title or Position: ADMIN
Credential: CPC,CPB,CPMA,CTA
Phone: 931-542-9420