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General NPI Number Information
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NPI Number | 1366909822
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Entity Type | Organization
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Legal Business Name | SOUTHERN SPINE AND SPORT LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 2530 N MOUNT JULIET RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3007
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Country | US
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Telephone | 615-758-6422
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Fax | 615-758-6422
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Provider Business Mailing Address
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Address Line | 3055 KIRKLAND CIR
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City | MOUNT JULIET
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State | TN
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Zip | 37122-8549
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Country | US
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Telephone | 615-758-6422
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Fax |
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Authorized Official
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Title or Position | HEAD CLINICIAN
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Name | DR. DANIEL HOLLAND
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Credential | DC
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Telephone | 615-758-6422
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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 |
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License Number State |
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