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General NPI Number Information
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NPI Number | 1285025254
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Entity Type | Organization
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Legal Business Name | PROMASSAGE & CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 907 RIVERGATE PKWY STE E4
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-2333
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Country | US
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Telephone | 615-448-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 907 RIVERGATE PKWY STE E4
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-2333
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Country | US
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Telephone | 615-448-6446
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CELISA ELLIS
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Credential | LMT
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Telephone | 615-448-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2840
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7924
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License Number State | TN
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