Healthcare Provider Details

I. General information

NPI: 1235644915
Provider Name (Legal Business Name): BODY SHOP CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 PROVIDENCE PKWY STE A
MT JULIET TN
37122-6384
US

IV. Provider business mailing address

2012 PROVIDENCE PKWY STE A
MT JULIET TN
37122-6384
US

V. Phone/Fax

Practice location:
  • Phone: 615-599-5226
  • Fax:
Mailing address:
  • Phone: 615-599-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS SHARP
Title or Position: DIRECTOR
Credential: DC
Phone: 615-559-5226