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General NPI Number Information
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NPI Number | 1437721529
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Entity Type | Organization
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Legal Business Name | ELK RIVER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 105 DAVIDSON ST E
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3580
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Country | US
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Telephone | 931-557-5111
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Fax | 931-967-5112
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Provider Business Mailing Address
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Address Line | 105 DAVIDSON ST E
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3580
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Country | US
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Telephone | 931-557-5111
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Fax | 931-557-5112
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. MARK TYLER EDGE
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Credential | CHIROPRACTOR
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Telephone | 904-521-6349
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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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