Healthcare Provider Details

I. General information

NPI: 1073271342
Provider Name (Legal Business Name): TULLAHOMA SPINE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARBURY XING
TULLAHOMA TN
37388-2215
US

IV. Provider business mailing address

111 MARBURY XING
TULLAHOMA TN
37388-2215
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-0408
  • Fax: 931-454-9377
Mailing address:
  • Phone: 931-455-0408
  • Fax: 931-454-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS FRANK STABILE
Title or Position: OWNER
Credential: DC
Phone: 931-455-0408