=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356210314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REALIGN CHIROPRACTIC,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2025
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2226 JACKSBORO PIKE STE 4
-----------------------------------------------------
City | LA FOLLETTE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37766-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-912-4894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2226 JACKSBORO PIKE STE 4
-----------------------------------------------------
City | LA FOLLETTE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37766-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-912-4894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD ZUPANCIC
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 423-912-4894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------