Healthcare Provider Details

I. General information

NPI: 1902783970
Provider Name (Legal Business Name): WILD BLOOM CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N WATER AVE STE B
GALLATIN TN
37066-2871
US

IV. Provider business mailing address

1117 WYNNEWOOD DR
CASTALIAN SPRINGS TN
37031-4831
US

V. Phone/Fax

Practice location:
  • Phone: 615-675-4273
  • Fax: 615-989-2515
Mailing address:
  • Phone: 405-464-7082
  • Fax: 615-989-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDI HUTCHISON-SLOANE
Title or Position: OWNER
Credential: DC
Phone: 615-675-4273