Healthcare Provider Details

I. General information

NPI: 1104986249
Provider Name (Legal Business Name): ROBERT MABRY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHURCH ST SUITE 180
NASHVILLE TN
37219-2320
US

IV. Provider business mailing address

500 CHURCH ST SUITE 180
NASHVILLE TN
37219-2320
US

V. Phone/Fax

Practice location:
  • Phone: 615-255-7900
  • Fax:
Mailing address:
  • Phone: 615-255-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC0000001896
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: