=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407147226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW LIFE CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2011
-----------------------------------------------------
Last Update Date | 04/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1746 GENERAL GEORGE PATTON DR SUITE 102
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-221-8033
-----------------------------------------------------
Fax | 615-221-8035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1746 GENERAL GEORGE PATTON DR SUITE 102
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-221-8033
-----------------------------------------------------
Fax | 615-221-8035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DIONNE KELLOGG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 615-221-8033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2164
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------