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General NPI Number Information
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NPI Number | 1124771118
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Entity Type | Organization
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Legal Business Name | TENNESSEE BACK PAIN CENTER LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 3242 MEMORIAL BLVD STE C
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City | MURFREESBORO
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State | TN
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Zip | 37129-3233
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Country | US
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Telephone | 615-900-5187
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Fax | 833-624-3035
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Provider Business Mailing Address
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Address Line | 475 SWANHOLME DR APT L209
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City | MURFREESBORO
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State | TN
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Zip | 37128-1521
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Country | US
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Telephone | 937-825-0788
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | TERESA ANN PORTER
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Credential | DC
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Telephone | 615-900-5187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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