MEDICARE: NEW LIFE CHIROPRACTIC INC

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	2164	TN

General Provider Information

NPI Number	:	1407147226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	1746 GENERAL GEORGE PATTON DR
Second Line	:	SUITE 102
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2935
Country	:	US
Telephone Number	:	615-221-8033
Fax Number	:	615-221-8035

Provider Business Practice Location Address
First Line	:	1746 GENERAL GEORGE PATTON DR
Second Line	:	SUITE 102
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2935
Country	:	US
Telephone Number	:	615-221-8033
Fax Number	:	615-221-8035

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DIONNE KELLOGG
Credential	:	D.C.
Telephone Number	:	615-221-8033

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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