Healthcare Provider Details

I. General information

NPI: 1861196495
Provider Name (Legal Business Name): OOLTEWAH REACH HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 LITTLE DEBBIE PKWY STE 108
COLLEGE DALE TN
37363-4333
US

IV. Provider business mailing address

5564 LITTLE DEBBIE PKWY STE 108
COLLEGE DALE TN
37363-4333
US

V. Phone/Fax

Practice location:
  • Phone: 423-498-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RHONDA BLACKWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 423-498-3400