Healthcare Provider Details

I. General information

NPI: 1649501040
Provider Name (Legal Business Name): DOUBLE LUNG PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 LEGENDS DR SUITE I
LEBANON TN
37087-5308
US

IV. Provider business mailing address

155 LEGENDS DR SUITE I
LEBANON TN
37087-5308
US

V. Phone/Fax

Practice location:
  • Phone: 615-453-8999
  • Fax: 615-453-8909
Mailing address:
  • Phone: 615-453-8999
  • Fax: 615-453-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18639
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY JASON BURCHARD
Title or Position: OWNER
Credential: D.C.
Phone: 615-453-8999