=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427584655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDTENN CHIROPRACTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2017
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7149 NOLENSVILLE RD SUITE A
-----------------------------------------------------
City | NOLENSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37135-9461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-819-0587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 222
-----------------------------------------------------
City | EAGLEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37060-0222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JORDAN QUINT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-217-0521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2438
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------