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General NPI Number Information
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NPI Number | 1811651748
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Entity Type | Organization
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Legal Business Name | CHAMPION WELLNESS
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 1047 GLENBROOK WAY STE 112
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1309
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Country | US
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Telephone | 615-447-3787
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Fax | 615-827-0149
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Provider Business Mailing Address
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Address Line | 3116 TYREE SPRINGS RD
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-8421
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Country | US
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Telephone | 813-340-4611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER CHAMPION
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Credential | DC, CCSP
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Telephone | 813-340-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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