Healthcare Provider Details

I. General information

NPI: 1801448758
Provider Name (Legal Business Name): HIGH COUNTRY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 LIBERTY CHURCH RD
MOUNTAIN CITY TN
37683-4305
US

IV. Provider business mailing address

638 GEORGE WILSON RD
BOONE NC
28607-8613
US

V. Phone/Fax

Practice location:
  • Phone: 423-727-7713
  • Fax:
Mailing address:
  • Phone: 828-773-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HAL NEILL BULLOCK
Title or Position: OWNER
Credential: D.C.
Phone: 828-773-5182