Healthcare Provider Details

I. General information

NPI: 1801885603
Provider Name (Legal Business Name): ANDERSON CHIROPRACTIC HEALTH AND WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 S COLLEGE ST
WINCHESTER TN
37398-2414
US

IV. Provider business mailing address

1431 S COLLEGE ST
WINCHESTER TN
37398-2414
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-6308
  • Fax: 931-968-9221
Mailing address:
  • Phone: 931-967-6308
  • Fax: 931-968-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number491
License Number StateTN

VIII. Authorized Official

Name: JERRY S ANDERSON
Title or Position: OWNER OF PRACTICE
Credential: DC
Phone: 931-967-6308