Healthcare Provider Details

I. General information

NPI: 1992126601
Provider Name (Legal Business Name): HERMITAGE CHIROPRACTIC AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 LEBANON PIKE SUITE 117
HERMITAGE TN
37076-2097
US

IV. Provider business mailing address

3441 LEBANON PIKE SUITE 117
HERMITAGE TN
37076-2097
US

V. Phone/Fax

Practice location:
  • Phone: 615-871-9000
  • Fax: 615-871-9018
Mailing address:
  • Phone: 615-871-9000
  • Fax: 615-871-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GREGORY BOBO
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 615-871-9000