Healthcare Provider Details
I. General information
NPI: 1427297365
Provider Name (Legal Business Name): SPINAL PAIN RELIEF CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/17/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1880 GENERAL GEORGE PATTON DR. SUITE 100
FRANKLIN TN
37067
US
IV. Provider business mailing address
1880 GENERAL GEORGE PATTON DR. SUITE 100
FRANKLIN TN
37067
US
V. Phone/Fax
- Phone: 615-373-0608
- Fax: 615-373-0668
- Phone: 615-373-0608
- Fax: 615-373-0668
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | 1229 |
| License Number State | TN |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | |
| License Number State | TN |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | 17958 |
| License Number State | TN |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2100X |
| Taxonomy | Acute Care Nurse Practitioner |
| License Number | 12987 |
| License Number State | TN |
VIII. Authorized Official
Name: DR.
BRENDAN
BARRY
WRIGHT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 615-373-0608