MEDICARE: MAGNOLIA CORPORATE WELLNESS, LLC

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	2567	TN
2	363LF0000X	Family Nurse Practitioner	7108	TN

General Provider Information

NPI Number	:	1205244845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA CORPORATE WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1524 WILLIAMS DR # 102
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-3274
Country	:	US
Telephone Number	:	615-225-9100
Fax Number	:	615-225-9105

Provider Business Practice Location Address
First Line	:	1524 WILLIAMS DR # 102
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-3274
Country	:	US
Telephone Number	:	615-225-9100
Fax Number	:	615-225-9105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID P MORRIS
Credential	:	DC
Telephone Number	:	615-225-9100

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/23/2024

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