MEDICARE: MISSION CHIROPRACTIC

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	DC0000002572	TN

General Provider Information

NPI Number	:	1336525427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION CHIROPRACTIC

Provider Business Mailing Address
First Line	:	206B COOL SPRINGS BLVD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7291
Country	:	US
Telephone Number	:	615-465-6642
Fax Number	:	615-224-3593

Provider Business Practice Location Address
First Line	:	206B COOL SPRINGS BLVD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7291
Country	:	US
Telephone Number	:	615-465-6642
Fax Number	:	615-224-3593

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONSON HOLLIDAY DYKSTRA
Credential	:	DC
Telephone Number	:	615-465-6642

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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Directions to “MISSION CHIROPRACTIC ” Practice Location

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