MEDICARE: DOUBLE LUNG PC

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
2	225100000X	Physical Therapist
3	225200000X	Physical Therapy Assistant
4	247100000X	Radiologic Technologist
5	363A00000X	Physician Assistant
6	363LF0000X	Family Nurse Practitioner	18639	TN
7	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1649501040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLE LUNG PC

Provider Business Mailing Address
First Line	:	155 LEGENDS DR
Second Line	:	SUITE I
City	:	LEBANON
State	:	TN
Zip	:	37087-5308
Country	:	US
Telephone Number	:	615-453-8999
Fax Number	:	615-453-8909

Provider Business Practice Location Address
First Line	:	155 LEGENDS DR
Second Line	:	SUITE I
City	:	LEBANON
State	:	TN
Zip	:	37087-5308
Country	:	US
Telephone Number	:	615-453-8999
Fax Number	:	615-453-8909

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY JASON BURCHARD
Credential	:	D.C.
Telephone Number	:	615-453-8999

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	11/26/2014

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Directions to “DOUBLE LUNG PC ” Practice Location

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