=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992953061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENN CHIROPRACTIC CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2008
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 377 HUNTLEY PARKWAY
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-621-5555
-----------------------------------------------------
Fax | 205-621-3500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 377 HUNTLEY PARKWAY
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-621-5555
-----------------------------------------------------
Fax | 205-621-3500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL GREGORY TENN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 205-621-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 2235
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------