MEDICARE: PREVENTIVE HEALTH INITIATIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2273	TN
2	163W00000X	Registered Nurse	191977	TN

General Provider Information

NPI Number	:	1154791481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE HEALTH INITIATIVE

Provider Business Mailing Address
First Line	:	2933 BERRY HILL DR STE A
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3126
Country	:	US
Telephone Number	:	615-200-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 BERRY HILL DR STE A
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3126
Country	:	US
Telephone Number	:	615-200-7122
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER MAY
Credential	:	DC, RN
Telephone Number	:	615-200-7122

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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