Healthcare Provider Details

I. General information

NPI: 1134414584
Provider Name (Legal Business Name): ASSOCIATES IN SPINE AND JOINT MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 KEITH ST NW
CLEVELAND TN
37312-3718
US

IV. Provider business mailing address

3372 KEITH ST NW
CLEVELAND TN
37312-3718
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-4751
  • Fax: 423-339-2692
Mailing address:
  • Phone: 423-476-4751
  • Fax: 423-339-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JAMES L SCHRODER
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 423-476-4751