Healthcare Provider Details

I. General information

NPI: 1659694685
Provider Name (Legal Business Name): TULLAHOMA CHIROPRACTIC AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 N JACKSON ST SUITE 110
TULLAHOMA TN
37388-8254
US

IV. Provider business mailing address

1940 N JACKSON ST SUITE 110
TULLAHOMA TN
37388-8254
US

V. Phone/Fax

Practice location:
  • Phone: 931-393-2401
  • Fax: 931-393-2402
Mailing address:
  • Phone: 931-393-2401
  • Fax: 931-393-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14261
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2217
License Number StateTN

VIII. Authorized Official

Name: MR. JOSEPH R KANAN
Title or Position: OWNER
Credential: D.C.
Phone: 931-393-2401